Augmentation Strategies in Rotator Cuff Repair: An Umbrella Review of Systematic Reviews and Meta-analyses - Protocol and Search Strategies v1.0

This record contains the full protocol and the validated search strategies for an umbrella review (review of reviews) of systematic reviews and meta-analyses evaluating intraoperative augmentation strategies in surgical repair of rotator cuff tears. Background: Intraoperative augmentation - structural patches and scaffolds, biological augmentation (platelet-rich plasma, bone marrow aspirate concentrate, bone marrow stimulation,stem cells, growth factors), and structural reconstruction (superior capsular reconstruction, subacromial balloon spacer) - is widely used at considerable cost, but the supporting systematic reviews reach directly opposing conclusions, including within the same journal in consecutive years. Clinicians cannot currently determine whether these discrepancies reflectgenuine differences in treatment effect or differences in the methodological quality of the reviews and in the primary studies on which they draw.Design: Umbrella review. The unit of analysis is the systematic review, not the individualprimary study. Methodological quality will be appraised with AMSTAR 2; overlap of primary studies across reviews will be quantified using the Corrected Covered Area; certainty of evidence will be assessed with GRADE. Search validation: The PubMed strategy was validated against a 32-item known-item set and retrieved 29 of 29 in-scope known reviews (100%) while returning 385 records, compared with 1501 records for a strategy without the intervention block.Registration: PROSPERO CRD420261503422, published 11 September 2026. Contents: Protocol v1.0 and Search Strategies v1.1. The AMSTAR 2 appraisal tables, theCorrected Covered Area analysis, the data extraction sheets and the PRISMA 2020 checklist willbe added as new versions as the review progresses.