Is an “Overlay” or “Interposition” scaffold more effective for full-thickness rotator cuff repair? Is there a benefit to using both approaches (nicknamed the “taco” by some)?

The rotator cuff is associated with fibrocartilaginous entheses, which provide a gradual transition from tendon to bone, accommodating both the tensile and compressive forces experienced in the shoulder joint.

“Overlay” scaffolds are placed on top of the rotator cuff and are traditionally secured using staples or sutures. This approach is designed to promote healing from the top of the tendon and provide mechanical integrity to the construct. What effect does this have on the tendon-bone interface (entheses) and overall healing?

“Interposition” scaffolds are placed between the rotator cuff and bone. They are traditionally made from synthetic polymers and rely on sutures from anchors to secure their position. This approach is designed to promote healing between the tendon and bone without adding significant mechanical integrity to the construct. What effect does this have on the tendon-bone interface (entheses) and overall healing?

The PHANTOM-X™ is the first and only scaffold with a delivery and security system that combines both the “Overlay” and “Interposition” approaches. The video demonstrates the ease of the delivery system and the novel design of the scaffold, which uses Aevumed’s proprietary 3D printing technology, BioTendon 3D™, to fabricate tendon-specific scaffolds.

Why limit full-thickness rotator cuff tears to just one approach when both can be used? Comments are welcome. It’s how we learn.

(PHANTOM-X™ is not yet on the market or FDA cleared.)