The role of new synthetic membranes in rotator cuff augmentation

Rotator cuff tears (RCTs) are a highly prevalent source of pain and disability. Despite advances in surgical repair techniques, high retear rates remain concerning. Biological augmentation using synthetic membranes has emerged as a promising strategy to enhance tendon regeneration and reduce the risk of repair failure. The purpose of this study is to present the currently available evidence regarding new bioinductive membranes. A narrative review of the literature was performed to identify commercially available bioinductive membranes for rotator cuff augmentation and to summarize the evidence supporting their use. Currently, there are four implants commercially available: Regeneten® (Smith & Nephew, Biobrace® (Conmed), Tapestry® (Zimmer Biomet) and Integrity® (Anika Therapeutics). These scaffolds act as bioinductive matrices, promoting new tendon-like tissue formation, intending to support the healing process and enhance the quality of the degenerative tendon, and reducing the risk of both failures at the tendon-to-bone interface and the occurrence of medial retears adjacent to the repair construct. All devices can be placed arthroscopically, although their fixation methods differ. Regeneten® has the most robust published evidence, whereas data on Biobrace® and Integrity® evidence remain limited, and no published outcomes are available for Tapestry®. Although complications are uncommon, cases of stiffness, inflammation and implant migration have been reported. Biologic augmentation with the new synthetic membranes is a promising technology that requires further attention. The use of the Regeneten implant seems to provide functional improvements in patients with partial tears and helps to avoid retears in full-thickness RCTs. The evidence for the other membranes is limited at best today.

Level V, expert opinion.