Efficacy and safety of xenograft augmentation in rotator cuff repair: a systematic review and meta-analysis.

Rotator cuff tears are common disorders that can significantly impact patientś shoulder function and quality of life. Incomplete or failed healing is relatively common following repair of large tendon tears. Xenograft materials are increasingly used for augmentation of repairs, but their efficacy and safety remain under debate. This systematic review and meta-analysis aimed to evaluate the outcomes of xenograft-augmented rotator cuff repair in comparison to standard repair techniques. A detailed literature search was conducted across PubMed, Embase, Cochrane Library, and Web of Science databases on September 2, 2023, focusing on studies that utilized xenograft materials in rotator cuff repair. We included randomized controlled trials (RCTs) and cohort studies (CHS) that reported on dichotomous and continuous outcome measures. Risk of bias was assessed using the Cochrane Risk of Bias tool 2 (RoB2) for RCTs and the Risk of Bias assessment for non-RCT studies-I tool for nonrandomized studies. Data synthesis was performed using random-effects models to compute odds ratios (ORs) and standardized mean differences. Eight studies met the inclusion criteria, including three RCTs and five CHS evaluating xenograft materials, including porcine dermis and small intestine submucosa patches. Meta-analysis of RCT data revealed no statistically significant difference in failure rates between xenograft-augmented and standard repair groups (OR 0.48, 95% CI 0.08-2.90;