Article Text

Healing rate and clinical outcomes of xenografts appear to be inferior when compared to other graft material in rotator cuff repair: a meta-analysis
  1. Yohei Ono1,2,
  2. Diego Alejandro Dávalos Herrera3,
  3. Jarret M Woodmass1,
  4. Richard S Boorman1,
  5. Gail M Thornton1,4,
  6. Ian K Y Lo1
  1. 1Department of Surgery, Section of Orthopaedic Surgery, McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, Alberta, Canada
  2. 2Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
  3. 3Department of Orthopedic Surgery, Colombia Universidad Nacional de Colombia, Bogota, Colombia
  4. 4Department of Orthopaedics, University of British Columbia, Vancouver, British Columbia, Canada
  1. Correspondence to Dr Ian K Y Lo, Department of Surgery, University of Calgary, 3280 Hospital Drive NW, Calgary, Alberta, Canada T2N 4Z6; ikylo{at}


Importance The use of grafts is a viable option for larger rotator cuff tears. Graft types can be divided into autograft (AU), allograft (AL), xenograft (XE) and synthetic (SY) material. However, the outcomes of each graft type are diverse.

Objective The objective of the study was to compare the healing rate and clinical outcomes of different graft materials.

Evidence review A systematic literature review was performed, and clinical studies of rotator cuff repair using grafts as augmentation or bridging were included. The primary outcome was tendon healing. The secondary outcomes included Visual Analogue Scale, American Shoulder and Elbow Surgeons Score and University of California at Los Angeles (UCLA) Score and forward elevation range. The studies were divided into AU, AL, XE and SY groups and compared. Analysis was a random effects model for healing rates and fixed effects models weighted by sample size for all the other measures.

Findings 23 studies with 25 study groups were included. A total of 130 (AU), 205 (AL), 111 (XE) and 202 (SY) repairs (mean age 63.7, 57.4, 63.5 and 63.7 years; mean follow-up 25.3 27.4, 28.6 and 26.4 months, respectively) were analysed. The estimated healing rates were 62.9% (AU), 78.9% (AL), 46.8% (XE) and 77.2% (SY), respectively. While no statistical significance was detected, the healing rate of XE was lower by more than 30% than AL and SY. The improvement of UCLA in XE was significantly less than the other 3 groups.

Conclusions and relevance The healing rate and clinical outcomes of XE appear to be inferior, however, the results varied. While graft type affects clinical outcomes, other factors may also be as important.

Level of evidence IV.

Statistics from


  • Contributors YO, GMT and IKYL involved in development of study protocol, data collection, data analysis and preparation and/or review of the manuscript. DADH, JMW and RSB involved in review of the manuscript.

  • Competing interests None declared.

  • Provenance and peer review Commissioned; externally peer reviewed.

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