Invited faculty at Shoulder360
Dr Kenneth Cutbush attended the Shoulder360 meeting in Miami as invited faculty, presenting on emerging technologies aimed at reducing rotator cuff retear rates following surgery.
What a rotator cuff repair involves
The rotator cuff is the set of four tendons that hold the ball of the shoulder in its socket and control the finer movements of the joint. When one tears away from the bone, a repair aims to bring the tendon edge back to its original footprint on the arm bone and hold it there while it heals. Most repairs are now carried out arthroscopically, through small portals with a camera, using anchors set into the bone and sutures passed through the tendon. The operation is followed by a period in a sling and a staged rehabilitation programme, because fixation holds the tendon in position but does not by itself make it heal. Individual results vary.
The subject of the talk
The talk covered three areas: surgical strategies, biologic technologies, and advances in fixation. These correspond to the three ways a repair can be improved. Surgical strategy concerns how the tear is configured and tensioned; fixation concerns how firmly the tendon is held to the bone while it heals; and biologics concern whether the tendon heals to bone at all, which is ultimately the limiting factor.
Retear remains the central unsolved problem in rotator cuff surgery, which is why it continues to occupy this much conference time.
With thanks to the organisers and to the fellow faculty.
Why retear is a difficult problem
A tendon does not reattach to bone in the way that two ends of a cut tendon knit to each other. The original attachment is a graded transition from tendon through cartilage into bone, built up over years of loading, and a repair heals instead with scar tissue that does not reproduce that structure. The size of the tear, how long the tendon has been detached, the condition of the muscle, age and general health all bear on whether healing occurs. That is why the three areas covered in the talk are pursued together rather than separately: better configuration and firmer fixation buy time for healing to happen, while biologic approaches are directed at the healing itself. Individual results vary.