The American Academy of Orthopaedic Surgeons’ updated rotator cuff guideline strongly recommends the use of biologic implants during repair — a move that could reshape practice patterns and patient access.
Robert Meislin, MD, an orthopedic surgeon at New York City-based NYU Langone Health, said the endorsement is significant given the academy’s traditionally conservative stance.
“For the Academy to come out and say they’re kind of giving us the green light to use it and to have their support is very exciting,” Dr. Meislin said.
Rotator cuff retears remain a persistent challenge, with rates ranging from 13% to as high as 90% depending on patient factors such as age, tissue quality, smoking and comorbidities.
Biologic scaffolds are designed to enhance tendon healing and reduce the risk of retear, and the academy’s recommendation signals greater confidence in their efficacy.
Dr. Meislin said tissue quality and tear characteristics are central to his decision-making.
Younger patients with poor tendon quality or complex tears may benefit more than older patients with strong, repairable tissue. Larger tears — defined as those three to five centimeters — are also more likely to warrant augmentation.
“I look at the quality of the tendon tissue,” he said. “If you have a delaminating tendon or more complex patterns like L- or U-shaped tears, I’m more likely to use a biologic scaffold.”
While he has not yet completed a full outcomes analysis of his patients with scaffolds, he has observed encouraging results. He also noted that the recommendation could shift payer coverage.
“Now, with the Academy giving forward for the use of scaffold, I think it’s going to make it harder for insurance companies to categorically deny its usage,” Dr. Meislin said.
Looking ahead, he expects adoption will grow as implants become easier to use and evidence of improved healing mounts. Expanded applications could even extend into medium-sized tears with poor tissue quality.
“The companies that are providing the biologic implants are constantly improving the delivery systems to make it easier for orthopedic surgeons to use,” he said. “Between ease of use and literature showing it strengthens repairs, I think surgeons are more likely to embrace it.”
