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 MRI is the primary tool for characterizing tendon tears, enabling assessment of tear size, retraction, tendon quality, muscle atrophy, fatty infiltration, and associated pathology. detailed MRI analysis assists in determining reparability and whether the tendon environment is favorable for augmentation. Assessment tear characteristics surgeons should evaluate tear pattern (for example, crescent versus U- or L-shaped for rotator cuff; mid-substance versus insertional for Achilles), chronicity, and degree of retraction. multi-tendon involvement, humeral head or tuberosity deformity, or chronic avulsion patterns may increase structural risk and influence the decision to augment. quality of tendon preoperative imaging and intraoperative inspection should assess tendon thickness, delamination, and suture-holding capacity. prior surgeries, calcification, and extensive degenerative changes may reduce healing potential and increase the appeal of a scaffold. tissue considerations tendon in reparable tears with compromised tendon quality, an onlay scaffold may provide a broader surface for suture purchase and a more favorable biologic environment. the tendon should still be able to be mobilized to the footprint without excessive tension to remain within intended use. gap after mobilization, the tendon–bone gap should be small enough to allow an anatomic or slightly medialized repair without bridging with scaffold alone. if the gap remains large despite mobilization, tendon transfer, reconstruction, or alternative strategies should be considered instead of relying on Tapestry to span the defect. degeneration chronic degeneration, including mucoid change and partial tearing, may necessitate debridement back to viable tissue before augmentation. systemic factors such as diabetes, smoking, and hyperlipidemia should be optimized preoperatively when possible. 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 exposure follows standard tendon repair principles, with careful soft-tissue handling to preserve paratenon and fascia. adequate visualization of the tendon, its footprint, and adjacent structures is necessary for precise scaffold placement. Placement position of the implant the tendon tear is repaired using the surgeon’s preferred technique before scaffold placement. the implant is hydrated according to manufacturer instructions as needed, trimmed to the desired size and shape, and positioned as an onlay over the repair with the intended surface facing the tendon. integration with anchors sutures destined for anchors may be passed through both tendon and scaffold prior to anchor deployment, or the scaffold can be placed after a completed repair and secured with additional sutures. the goal is broad, uniform contact between the implant and tendon, with the scaffold closely conforming to the repair footprint. Fixation suture techniques high-strength sutures are used to secure the scaffold, often continuing or supplementing the existing repair construct. mattress, rip-stop, or combined configurations can be used to distribute load and minimize the risk of suture cut-through. tensioning before final knot tying, the joint is positioned to maintain appropriate tension on the repaired tendon while ensuring the scaffold lies smoothly without folds. over-tensioning can restrict motion or create stress at implant edges, whereas under-tensioning can permit micromotion and abrasion. Closure layered closure closure should reconstitute anatomic layers, including paratenon or retinaculum when present, followed by fascia, subcutaneous tissue, and skin. care should be taken not to create excessive compression or shear over the scaffold. dressings and immobilization standard sterile dressings and immobilization approaches for tendon repair are appropriate and generally unchanged by the use of a scaffold. rehabilitation should follow tendon-specific protocols based on repair quality and patient risk profile rather than on scaffold use alone. 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.