Arthroscopic Bioinductive Collagen Scaffold Augmentation in High-Risk Posterosuperior Rotator Cuff Tears: Clinical and Radiological Outcomes

<b>Background/Objectives:</b> Bioinductive bovine collagen implants (BCI) have been introduced to enhance tendon biology and promote tissue regeneration in rotator cuff (RC) repairs. This study aimed to assess the clinical and radiological outcomes of arthroscopic posterosuperior rotator cuff (psRC) repair with BCI augmentation in full-thickness tears at increased risk of retear. <b>Methods:</b> This case series analyzed 30 patients with psRC tears who were classified as being at high risk of failure according to a predefined set of parameters, including patient history, radiological findings and intraoperative assessments, and the presence of psRC retears. All patients subsequently underwent arthroscopic psRC repair with BCI augmentation, compromising 21 primary and 9 secondary repairs. Clinical outcomes were assessed using Subjective Shoulder Value (SSV), American Shoulder and Elbow Surgeons (ASES) shoulder score, and Constant score at 6 and 12 months postoperatively. Tendon integrity was assessed using the Sugaya classification. <b>Results:</b> At 12 months, magnetic resonance imaging revealed complete tendon healing in 56.7%, partial healing in 16.7%, and insufficient healing in 26.7%. Significant improvements in SSV (45.3 to 83.5), ASES (40.6 to 77.8), and Constant score (36.6 to 71.7) were observed at 12 months postoperatively, with all outcome measures exceeding their respective minimally clinically important differences. Two patients (6.7%) developed secondary shoulder stiffness, and 1 patient (3.3%) required revision surgery for bicipital groove pain. <b>Conclusions:</b> Augmentation with a BCI in arthroscopic repair of high-risk psRC tears demonstrate promising short-term results. Patients achieve significant improvements in pain and shoulder function, accompanied by satisfactory tendon healing on MRI.