- October 31, 2017
My name is Dr. Christopher Baker. I’m an orthopedic surgeon at the Florida Orthopaedic Institute in Tampa, Florida. I specialize in sports medicine and advanced shoulder surgery that includes both arthroscopic surgery as well as total shoulder arthroplasty of the shoulder. I’ve been doing a arthroscopic rotator cuff repairs for the past seven years in Tampa and I’ve been utilizing the rotation medical bio inductive implant for the past year and a half. The rotator cuff is a literally a cuff of tissue that surrounds the ball and socket joint of the shoulder, the ball and socket joint. We’re all familiar with the deltoid and biceps and triceps and other muscles around the shoulder, but in order to keep the ball in the shallow socket, you need a cuff of tissue that goes around the shoulder that has muscular and tendonous attachments and that helps keep the ball in the shoulder as the shoulder moves.
Rotator cuff tears are very, very common in our community and in our society to the point where as you age, your likelihood of having a rotator cuff tear goes up substantially. There’ve been studies done with both MRIs and ultrasounds that show that up to 50% of patients over the age of 70 have a rotator cuff tear. If your mother and father have had a rotator cuff tear, you’re more likely to have a rotator cuff tear than another person. Rotator cuff tears can also occur from injuries such as with falls or lifting type injuries. Most rotator cuff tears can really be diagnosed based on a history and physical in elderly patient who has had chronic pain and weakness over time is more likely to have a tear than a younger patient that hasn’t had an injury. The most common imaging modality to diagnose a rotator cuff tear is the MRI.
The MRI allows us to look at the shoulder from within without having to be invasive. However, it does require you to lie in a tube for uppers of 45 minutes. I’ve developed in my practice the ability to utilize the ultrasound, which is something that people are familiar with for looking at babies in the mother’s womb and you can actually look at the rotator cuff that way and diagnose a rotator cuff tear as well. And what we’re looking at generally when we’re looking at the rotator cuff is actually this cuff of tissue that goes around the ball and socket joint of the shoulder. So this cuff of tissue that keeps that ball in the shoulder becomes torn in, that ball starts to come out of the socket and actually rub against the bone on top of the shoulder. And what needs to be done in order to fix that is we either need to tether that rotator cuff back down to the bone using traditional anchors or screws and suture.
And in some cases we’re able to do that and need augmentation such as in the rotation patch and other cases we do not. In the past, what I’ve had to do in those patients who needed a patch or augmentation of their repair is I would actually use human dermis and we actually harvest human dermis from a cadaver, process it and sterilize it and actually fashion it so that it will fit in the shoulder. That process can take anywhere from an hour and a half to three hours of surgery. With the rotation medical patch, we’re able to actually utilize that same idea and do it in a matter of five to 10 minutes, again, through percutaneous or small incisions. It really enhances my ability to speed up the surgery and enhances the patient’s recovery in that they aren’t laid down for so long. And in some cases we’re actually able to accelerate the rehabilitation.
The way that the rotation medical bioinductive implant is utilized is of several different varieties. One is to actually augment a repair. So we do a standard rotator cuff repair with anchors and sutures, and then we put the bio inductive implant on top and other types of repairs. We actually don’t actually need to use traditional forms of repair with rotator cuff anchors or sutures. We’re actually able to utilize just the patch itself or the bio inducted implant itself and place it on the actual rotator cuff defect. So in this case, what we do is make a small stab incision. There’s actually an insertion device that actually implants the shoulder itself. So, we’ll place the, the device on here. We’ll slide it through a small stab hole in the shoulder, which will then lay out the the graft and actually the bio inductive implant will be then splayed over top of our repair area.
We then have these little portals that are used through little stab incisions and those stab incisions are utilized to place a small anchors that will actually secure the graft to the rotator cuff. So it’s a very small, a sophisticated and a slick kind of way of placing the implant. So the rotation bio inductive implant is really helpful in my practice. It can be used in primary settings in the case of a rotator cuff tear that has never been addressed by another surgeon. It can also be addressed in revision settings. In patients who have had prior rotator cuff repair that has not failed. I can go in and repair that rotator cuff and then augment that, that area with this bio inductive implant, which will then increase the, hopefully the, the probability of this healing. The bioinductive implant is actually really interesting because even though it’s made a bovine Achilles, a collagen fibers, it actually is absorbed over 30 to 90 days by the patient’s normal reparative process. So after 90 days or so if you go in and actually take a biopsy of this region, it actually is entirely the patient’s tissue and there’s no foreign body reaction or allergic type reaction that is seen in other types of graphs. The procedure for the rotator cuff repair, including the rotation bio inductive implant is an outpatient procedure. You’ll generally come in in the morning you’ll undergo your procedure, usually with a localized block. You’ll receive a light anesthesia and then you’ll go home that very same day with a sling.
So I’ve been performing the rotation, medical bio inductive implant, a procedure for a little over a year and a half. Now I’ve done this in over 20 patients, most of which were a severe type of repairs in that they were so large that the probability of them healing was very low. Other patients were actually revision patients that other surgeons had repaired their shoulder and didn’t feel like they could be repaired any more. So they sent them to us for a second opinion. In those cases, a lot of those patients are able to be undergo a revision procedure where we can revise the repair and then place that bio inductive implant on top of the repair to increase the chances that it can heal. We’ve had really good successes with that in the short and the long-term. We’ve looked at these with MRIs after surgery as well as ultrasound after surgery and had really good healing responses in these patients with very high failure rates in some patients with what are called partial thickness rotator cuff tears.
Traditionally what we do is we actually complete the rotator cuff tear and create a full thickness rotator cuff tear that we would repair with the screws and sutures. What the bio inductive implant allows us to do in those particular patients is we don’t know, we no longer have to actually complete the rotator cuff tear, so they actually stay with their partial rotator cuff tear. We’ll then place that that bio inductive implant directly on the damaged tissue without any open repair or take down of the original tissue. In that particular case, those patients will have a much-accelerated rehab and hopefully a much quicker recovery with less pain. I’ve been doing complex shoulder reconstructive surgery in Tampa for about seven years now. What this has done now is it’s taken my standard large, massive rotator cuff repairs and it’s really turned them into small repairs. It’s now something that is on my schedule for an hour, like a traditional rotator cuff, with a five-minute addition of the bio inductive implant. So I went from a three hour to an hour and a half addition to regular surgery. Cutting that down to five or 10 minutes of additional surgery with what seems to be similar results is very, very much a change in my practice.