Bioinductive collagen implant augmentation for rotator cuff repair: a systematic review, meta-analysis and meta-regression - 12/11/26

Doi : 10.1016/j.otsr.2026.104991

Abdulateef Mohammed Atallah ^a, Salman Mohammed Alfawaz ^b, Fahad Ali Alabduljader ^c, Yousef Ahmad Alenezi ^d,⁎ , Yousef Mesaed Al-Shammari ^e, Saleh Yaqoob Rouhaldeen ^f, Shuaib Yaqoob Rouhaldeen ^f, Abdulaziz Khurshed ^g

^a New Jahra Hospital, Ministry of Health, Al Jahra, Kuwait City, Kuwait

^b Physical Medicine and Rehabilitation Department, Ministry of Health, Shuwaikh, Kuwait City, Kuwait

^c Orthopedic Department, Al-Razi Hospital, Ministry of Health, Kuwait City, Kuwait

^d Al-Jahra Hospital, Ministry of Health, Al Jahra, Kuwait City, Kuwait

^e Department of Ophthalmology, Al-Bahar Eye Center, Ibn Sina Hospital, Ministry of Health, Kuwait City, Kuwait

^f Faculty of Medicine, Alexandria University, Alexandria, Egypt

^g Department of Orthopaedic Surgery, Ministry of Health, Kuwait City, Kuwait

^⁎ Corresponding author.

Sous presse. Épreuves corrigées par l'auteur. Disponible en ligne depuis le Thursday 12 November 2026

Graphical abstract

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Abstract

Introduction

Rotator cuff tears are a common cause of pain and dysfunction in the shoulder, and the healing of the structure after repair is a major concern. Bioinductive collagen implants are now being added as an aid in rotator cuff repair to improve tendon healing. The purpose of this study was to systematically review the clinical and structural outcomes of the addition of bioinductive collagen implants in rotator cuff repair.

Methods

A systematic review and meta-analysis were done according to the PRISMA guidelines. Electronic searches of PubMed, Embase, and Scopus were performed from database inception through February 2026. Studies evaluating rotator cuff repair augmented with a bioinductive collagen implant were considered eligible. Continuous outcomes were synthesized as pooled mean values with standard deviations, while outcomes reported as event counts were analyzed using pooled event-total proportions with the Freeman–Tukey double arcsine transformation under a random-effects model. Heterogeneity was assessed using Cochran’s Q test and the I² statistic. Sensitivity analyses were performed using a leave-one-out approach.

Results

Nineteen studies involving 1,407 patients were included overall, although the number of studies contributing to individual pooled outcomes varied. Pooled postoperative tendon thickness was 6.77 mm at 6 months (2 studies, n = 38), 6.71 mm at 12 months, (2 studies, n = 38) and 4.24 mm at 24 months (4 studies, n = 170). The pooled postoperative ASES scores were 71.5 at 3 months, 84.9 at 12 months, and 93.7 at 24 months, while the corresponding Constant-Murley scores were 63.7, 76.6, and 86.9. The pooled structural failure rate was 20.2%, with moderate heterogeneity. Leave-one-out sensitivity analyses demonstrated stability of the pooled estimates.

Conclusion

Available studies report favorable postoperative structural imaging and functional outcomes following rotator cuff treatment with bioinductive collagen implants. However, because the evidence is predominantly non-comparative, the incremental clinical benefit attributable specifically to the implant remains uncertain. Further high-quality comparative studies are required to determine clinical efficacy and identify the patient populations most likely to benefit.