Rotator cuffs: more patients and surgeons seek arthroscopic alternative for shoulder injuries.

The shoulder joint is one of the most used and abused in our bodies. We expect a lot from it, but sometimes the body sends us a message that it just can't comply with our every wish. Trauma to the joint or sports involving repetitive, overhead motion like that in golf, tennis, swimming and throwing, can cause injury to the shoulder. So can everyday occupational activities such as lifting, gardening, and window washing.

When the rotator cuff--a four muscle-tendon unit that mobilizes and stabilizes the shoulder--is injured by overuse, surgery is sometimes necessary to repair it. In the US, an estimated four million people seek medical attention for shoulder injuries and nearly 300,000 of them will undergo surgical repair of the rotator cuff. Because most of these procedures are performed with a traditional "open" incision, which is by nature somewhat invasive, many patients may defer treatment. Those who do have the surgery can expect the recovery process to take some time. The arthroscopic rotator cuff repair is a minimally invasive technique to repair the torn rotator cuff tendon without an "open" incision or damage to the overlying deltoid muscle. This avoids cutting through muscle and so the repair is made completely through small, arthroscopic punctures rather than long incisions. The advantage is an outpatient procedure with less peri-operative pain, and smoother recovery. However it is an advanced technique that requires specialized equipment, advanced arthroscopic skills and knot tying techniques, and a dedicated OR team.

This kinder cut comes from a device called the AutoCuff, made by Opus Medical, a division of ArthroCare Sports Medicine. AutoCuff allows the surgeon to repair the rotator cuff arthroscopically without the potential for knot tying failures.

Colorado-based orthopedic surgeon Richard Hawkins, M.D., who is founder of the Steadman Hawkins Clinic and head team physician for the Denver Broncos is a long-time proponent and pioneer of arthroscopic procedures. He explains, however, that to become more commonplace, totally arthroscopic procedures must overcome obstacles that are inherent to the procedure, including the cumbersome "anchor" systems commonly used, the need for improved suture management and the elimination of the knot-tying process.

"The weakest link in arthroscopic rotator cuff repair is the knot tying," said Dr. Hawkins.

"That's because no two arthroscopic knots are tied the same. As a result, arthroscopic cuff repair is difficult to reproduce and leaves a stack of bulky knots in the joint. This is coupled by the challenge and frustration of not being able to rapidly and directly place asecure stitch in the rotator cuff."

The AutoCuff system itself is comprised of two instruments--the SmartStitch Suturing Device and the Magnum Knotless Fixation Implant. When used together, they eliminate the shortcomings of current shoulder repair devices. The SmartStitch Suturing Device delivers a unique "incline" mattress stitch directly into the tissue in a matter of seconds. The surgeon then loads and deploys the Magnum Implant, a device containing an internal mechanism that provides cinchable and reversible suture tension to achieve an excellent tissue-to-bone interface result--without knots.

"The AutoCuff device allows two points of fixation on the tendon and can provide a better footprint for tendon healing," said orthopedic surgeon Robert H. Bell, MD of Crystal Clinic in Akron Ohio. "It's advantageous because you can grasp the tendon, pass the suture loop through the tendon from the top down and into the bone anchor, which has been installed in a small (3.2mm) hole."

"There, the suture is anchored through the bone anchor, and you have the flexibility to pull the tendon as snugly to the bone as you need to," said Dr. Bell. "Once this is done, the suture can be crimped in place very strongly; the handle is pulled off the suture anchor and the procedure is complete."

Arthroscopic rotator cuff repair has become a commor procedure for Dr. Bell and his colleagues and he reports that the AutoCuff has become a consistent performer in the differing array of techniques necessary to repair the variety of shoulder injuries encountered.

As arthroscopic rotator cuff repairs become more popular among surgeons globally, doctors hope this new, minimally invasive treatment option will encourage more individuals to seek treatment for their injured shoulders. For those of us who have suffered with torn rotator cuffs but have been wary of open surgery, this is indeed promising news.

Corrine Novato is a freelance writer specializing in health care.