Update on Extra-cellular Matrix Patches, August 2012

1. ECM Patches
Alan M. Hirahara, M.D., FRCS(C)
Board Certified in Orthopaedic Surgery & Orthopaedic Sports Medicine
Specializing in arthroscopic shoulder surgery
Medical Director Team Physician Consultant
Sacramento State Athletics Sacramento River Cats Oakland A’s
MiLB - AAA

2. ECM Patches
• 20 – 57% failure rates reported for RC repairs
• In vivo animal studies support use of acellular dermal grafts for
augmentation
• Biomechanical studies show dermis grafts superior suture retention over
SIS or BM patches
• Several “acellular” grafts still contain significant DNA
– GraftJacket, Restore, TissueMend
Adams et al. Arthroscopy 2006.
Aurura et al, J Shoulder Elbow Surg 2007.
Coons et al, Sports Med Arthrosc Rev 2006.

3. ECM Patches –
Strength Comparison
Barber et al, Arthroscopy, 2009.

4. Augmentation
• Peer reviewed clinical studies do not support SIS grafts
• Iannotti et al, (JBJS 2006) - Randomized prospective controlled trial using (Restore) augmentation for
massive tears showing no benefit using SIS. Discontinued study early!
• Walton et al. (JBJS 2007) - 19 pts. 4 of which had severe early inflammatory rxn. 2 yr. MRI shows no
difference in failure rate vs non-augmented, abandoned study early! Porcine graft (Level 3)
• Schlamberg et al. (J Shoulder Elbow Surg 2004) – All patients re-tore
• Zheng et al. (J Biomed Mater Res B Appl Biomater 2005) – Adverse outcomes related to retained
cellular elements
• Dermis grafts show potential
• Burkhead et al. (Semin Arthroplasty 2007) – 17 pts, GJA augmentation, 1.2 yrs F/U, improved UCLA
scores but 3 retears per MRI & no reversal of atrophy or fatty infiltration. No Control group

5. RCR with Graft Augmentation

6. Intercalary Placement
• Biomechanical studies showing equivalent
load-to-failure and mechanical properties, but
few articles show success clinically
• Snyder et al. (IJSS 2007) – Retrospective 2 yr f/u 16 pts interposition GJA with
improved UCLA scores but persistent weakness overhead & 3 re-tears. (Level
4 consecutive clinical series)
• Schlamberg et al. (J Shoulder Elbow Surg 2004) – 7 interposition Restore
grafts. All re-tore

7. Thank You!