Editorial Commentary: Insurance Peer-to-Peer Reviewers Take Notice! Yet Another Study Showing Benefit for Patch...

Large and massive rotator cuff tears carry a concerningly high retear rate after primary repair, representing a persistent challenge in shoulder surgery. Patch augmentation-using allograft, autograft, xenograft, collagen, enthesis augments, or synthetic materials-has emerged as a promising strategy to improve both the mechanical and biologic properties of the repair construct. A growing body of evidence, including systematic reviews and meta-analyses, shows that patch augmentation reduces retear rates and improves clinical outcomes compared with repair alone. Despite this evidence, payor approval for augmentation devices remains inconsistent, limiting patient access worldwide. In my opinion, augmentation is not optional for large to massive rotator cuff tears at high risk of retear-it is essential. Peer-to-peer reviewers and insurance medical directors should take note: the evidence supports augmentation for many such strategies, and withholding coverage does patients a disservice.