The presentation
A presentation at ISAKOS 2025 in Munich on a biological approach to arthroscopic rotator cuff repair, using the EnFix prosthesis from Tetrous to add demineralised bone fibres at the tendon-bone interface.
What ISAKOS is
ISAKOS is the International Society of Arthroscopy, Knee Surgery and Orthopaedic Sports Medicine. It is a global society for surgeons who work on joints through keyhole techniques and who treat sports injuries, and its congress is held every two years in a different country. The programme combines presentations of new research with instructional courses, consensus work in which committees attempt to agree a position on contested questions, and surgical technique sessions. For work that is still at an early stage, a congress of this kind is where it is first tested against questioning from surgeons in other countries who may have reached different conclusions.
The problem
Rotator cuff retear rates can reach 40%. The underlying reason is biological rather than mechanical: a repaired tendon does not reliably reform the specialised transition zone, called the enthesis, that originally connected it to bone. Instead it tends to heal with scar tissue, which is weaker than the structure it replaces.
The approach
The aim of adding demineralised bone fibres at the interface is to encourage the formation of a more natural enthesis rather than scar. Histological and biomechanical findings from animal studies have reported stronger repairs and more natural interfaces with this approach.
An important qualification: that evidence comes from animal studies. Human clinical outcome data was not presented, and preclinical findings do not always translate. This is a promising line of work rather than established practice, and individual results vary.
How an idea like this is tested
Work of this kind follows a long sequence. A material is first examined in the laboratory, then in animal models where the repaired tissue can be looked at directly under a microscope and loaded to failure to measure its strength. Only after that does it reach human studies, beginning with small series reporting safety and healing on scans, and eventually comparative trials against standard repair. Each stage can halt the idea, and findings in animals regularly fail to hold up in people. Describing where a technique sits in that sequence is part of presenting it honestly. Individual results vary.