Repairing a partial tendon tear in the shoulder’s rotator cuff may simply be a matter of “patching” it, says noted orthopedic surgeon Alejandro Badia, MD. An expert in shoulder surgery, as well as regenerative medicine, Dr. Badia, has been successfully using an all-natural, collagen patch to promote healing of the rotator cuff tendon. Called the REGENETEN◊ Bioinductive Implant system, the patch is made from highly purified Achilles tendon of cows and grafted onto the torn section of tendon in a minimally invasive, arthroscopic procedure. For smaller tendon tears, the patch may be all that the patient requires, thereby avoiding more extensive surgery.
Dr. Badia refers to it a “breakthrough approach.”
“Rotator cuff tears are the most common source of shoulder pain and disability, affecting more than four million people annually in the United States,” says Dr. Badia, founder and chief medical officer of the Florida-based Badia Hand to Shoulder Center and OrthoNOW®. “The bio-inductive implant disrupts progression of rotator cuff degeneration by stimulating growth of new tendon tissue.”
Although longer-term studies are needed, the patch may actually limit the likelihood that a repaired rotator cuff tendon will later fail. That’s because regeneration of tendon tissue reduces strain at the site of the injury. The patch is gradually absorbed by the body, leaving behind “tendon-like” biological material serving as a scaffold that supports the repaired rotator cuff tendon — a significant benefit since larger tears requiring surgery can re-tear more than 40 percent of the time, Dr. Badia explains.
Patients undergoing patch therapy also tend to resume normal activities more quickly than those undergoing standard treatments. “Recovery from standard surgery is often longer and more painful,” he says. Furthermore, these patients seem to have much less post-op pain and begin moving the arm within days, depending upon the surgeon’s particular protocol, but generally much earlier than with traditional repairs. Nick Mendez, CEO of OrthoNOW®, recently underwent a combined labral repair along with Regeneten® augmentation of a concomitant partial cuff tear noting “I had essentially no post-op pain which I attribute to the technique, implant and the type of anesthetic block used”.
A further usage of the Regeneten® implant is for augmentation of massive tears that are often doomed to failure due to poor tissue quality and retraction of the tendon. Dr. Amy Chappell, a neurologist and prominent lifestyle medicine physician, recently underwent a “double row” rotator cuff repair where even achieving a repair was challenging. Her early clinical outcomes were remarkable due to the reinforcement of that repair with this bioinductive implant. Dr. Chappell notes, “I recovered my functional range of shoulder motion within 6 weeks of the surgery and all of the pre-operative pain is gone. I am now returning to my previous fitness regimen and lifestyle.”
Dr. Badia calls the shoulder, particularly the rotator cuff complex, a “demanding joint” for both patient and treating surgeon. The cuff consists of a stabilizing confluence of four major tendons from muscles that keep the head of the upper arm bone in the shoulder socket, allowing the arm to be raised and rotated. Partial — or complete — tears of these tendons can occur from normal wear over time; repetitive use as occurs in certain sports, such as tennis, and in occupations like painting or carpentry; and injury from falls or heavy lifting.
Symptoms of rotator cuff problems can include a dull ache in the shoulder, arm weakness, difficulty in lifting or rotating an arm and disturbed sleep. Partial tendon tears degenerate and become much larger if not resolved quickly. Interestingly, partial tears are often more painful than complete tears causing patients to seek medical attention, but treatment options have been limited until now.
Dr. Badia indicates that most partial thickness tears – up to 80 percent – increase in size and severity within two years without medical intervention and, if left untreated, might lead to permanent joint problems, including weakness and loss of shoulder motion.
Researchers have been long seeking a “gold standard” of therapy for rotator cuff repairs. Despite the variety of surgical techniques studied and resulting improvements in repairing tendons and re-fixing them to bone when necessary, healing outcomes have remained relatively stable, with the same high failure rate of tendon re-tears and damage.
“We have become quite proficient at mechanical repairs of the shoulder, but not the biological aspects,” says Dr. Badia, adding that “biological factors” like tendon degeneration, declining vascularity of tendons, and muscle atrophy are the more likely culprits today for high rotator cuff failure rates following surgery.
He concurs with scientists who say that regenerative medicine, including use of biologic scaffolds and patches like the REGENETEN◊ Bioinductive Implant, pose exciting new possibilities for enhancing the success of joint repair.
In fact, all-natural treatments may eventually prove effective substitutes for more invasive surgical techniques, thereby encouraging patients to undergo rotator cuff repairs earlier, before the problem worsens, and opening up the possibility of surgeons performing successful procedures on older patients, those 70 years of age and older, for whom traditional surgery has not always been the best option, Dr. Badia says.
Of course, prevention is the best medicine. That’s why Dr. Badia offers these tips to prevent shoulder-joint problems:
- Learn how to do stretches – like the sleeper stretch and cross-arm stretch – to strengthen the shoulder’s internal and external rotation.
- Strengthen the rotator cuff specifically, requiring different exercises than traditional “gym” routines that work the more “showy” deltoid muscle seen externally.
- Adequately warm up before playing sports or engaging in other vigorous activities that stress the shoulder.
- Pay attention to proper technique when lifting, especially anything heavy.
- Take breaks when using repetitive arm and shoulder motions like painting; avoid keeping arms raised or out from the side for long periods of time.
- If experiencing any ongoing shoulder pain or weakness, see an orthopedic specialist. “Don’t just blame the problem on arthritis or age.”
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