Summary TAPESTRY is intended to reinforce the repair site, provide a porous collagen-rich matrix for cellular ingrowth, and support tendon-like tissue formation as it gradually resorbs. The biointegrative scaffold in reparable tears with poor or thinned tendon tissue, large or massive tears, revision tendon repairs, and high-risk lower-extremity tendons such as Achilles, patellar, quadriceps, proximal hamstring, and gluteus medius. It is aimed at balancing early mechanical support with progressive biologic integration. Indications Indications tapestry is intended for the management and protection of tendon injuries in which there is no substantial loss of tendon tissue, functioning as an onlay scaffold rather than a tendon substitute. the implant is designed to be used in conjunction with standard tendon repair techniques (such as anchor- or transosseous-based repairs) to provide a protective, biointegrative layer. typical scenarios for potential use include reparable large or massive rotator cuff tears with compromised tendon quality, revision tendon repairs, and high-risk lower-extremity tendons, provided the tendon remains reparable. Contraindications active local or systemic infection and grossly contaminated surgical fields are general contraindications to implantation of a biointegrative scaffold. known hypersensitivity to bovine collagen or other implant components is a specific contraindication. irreparable tendon defects with substantial tissue loss, where continuity cannot be achieved with acceptable tension, fall outside the intended use of Tapestry as a non-bridging onlay. surgeons should refer to the official instructions for use for a complete and current list of indications, contraindications, warnings, and precautions. Anatomy Osteology shoulder applications involve the greater tuberosity and rotator cuff footprint on the proximal humerus, the acromion and subacromial space, and related bony landmarks of the scapula. lower-extremity landmarks include the calcaneal tuberosity for Achilles repairs, the patella and tibial tubercle for patellar and quadriceps tendon repairs, the ischial tuberosity for proximal hamstring repairs, and the greater trochanter for gluteus medius augmentation. Muscles shoulder-related tendon augmentations most commonly involve the supraspinatus, infraspinatus, subscapularis, and occasionally teres minor or pectoralis-related repairs. lower-extremity targets include the Achilles tendon, quadriceps and patellar tendons, proximal hamstring origin, peroneal tendons, and gluteus medius or minimus. Ligaments the implant may be used in procedures involving tendon-like capsuloligamentous structures such as the AC joint capsule or lateral ankle complex, where additional surface protection and biologic support are desired. in these settings, the scaffold supplements, but does not replace, primary ligament repair or reconstruction. Nerves in shoulder surgery, critical neural structures include the axillary nerve along the inferior border of the deltoid, the suprascapular nerve at the suprascapular and spinoglenoid notches, and the musculocutaneous nerve near the anterior shoulder. around the hip and pelvis, the sciatic nerve lies close to the proximal hamstring origin, requiring cautious dissection and anchor placement. in the lower extremity, relevant nerves include the common peroneal nerve at the fibular neck, the sural nerve in the posterolateral hindfoot, and the tibial nerve and its branches around the tarsal tunnel. Blood supply tendons are relatively hypovascular, relying on small vessels from musculotendinous and osteotendinous junctions and peritendinous tissues. preserving paratenon and minimizing unnecessary stripping from bone help maintain vascularity that supports both native tendon healing and scaffold integration. controlled microfracture or footprint decortication can introduce marrow-derived elements that may infiltrate the tendon–implant interface. Preoperative Planning Imaging MRI login to view 2 more bullets Assessment tear characteristics login to view 2 more bullets quality of tendon login to view 2 more bullets tissue considerations login to view 9 more bullets Approach Standard arthroscopic or mini-open approaches for rotator cuff repair are generally compatible with Tapestry augmentation and do not require major changes in portal placement. Open approaches for Achilles, patellar, quadriceps, proximal hamstring, and gluteus medius repairs provide ample exposure for scaffold contouring and fixation. Incisions and portals should be planned to protect nearby neurovascular structures while allowing direct visualization of the tendon footprint and sufficient working space for suturing the implant. The implant can be used in both open and arthroscopic workflows, and surgeons can adapt existing techniques to incorporate the scaffold without fundamentally altering their preferred repair method. Technique Exposure incision or portals login to view 2 more bullets Placement position of the implant login to view 2 more bullets integration with anchors login to view 2 more bullets Fixation suture techniques login to view 2 more bullets tensioning login to view 2 more bullets Closure layered closure login to view 2 more bullets dressings and immobilization login to view 2 more bullets Technical specifications Implant sizes and configurations tapestry is supplied as single-use, sterile flat patches in several sizes to accommodate different tendon footprints and surgical approaches. some configurations may incorporate an orientation or insertion sleeve to assist with handling and proper alignment during placement. Design features the implant exhibits a highly aligned inner fiber architecture intended to approximate tendon fascicles and support longitudinal load transfer. the outer surface is more unaligned and compliant, designed to interface with surrounding tissue and accommodate motion. engineered porosity and pore size distribution are intended to balance mechanical strength with fluid absorption and cellular ingress. Bioresorption and tissue replacement in preclinical studies, the PDLLA–collagen matrix gradually degrades over many months as host collagenous tissue infiltrates and replaces the scaffold. the exact resorption timeline in humans may vary and is influenced by local mechanical and biological conditions. Packaging and sterility tapestry is provided as a sterile, single-use implant that must be handled with standard aseptic technique. the implant should not be resterilized or reused; once removed from its packaging and exposed to the operative field, it should be implanted or discarded.