Buttoning Up a Torn Rotator CuffSurgeons are constantly looking for ways to improve rotator cuff repair. The rotator cuff is made up of four shoulder muscles whose tendons form a "cuff-like" attachement on the top rim of the shoulder.
A new approach to rotator cuff repair uses an anchoring or fixation device. This is called a button anchor. There are many different kinds of anchors available. Anchors may be made of bone or biodegradable materials such as metal or plastic. The surgeon drills a hole in the large bony bump on the shoulder. The anchor is then inserted through the hole and turned crosswise. The torn tendon is attached to the anchor with tiny stitches.
How do surgeons know the anchor will hold? Studies of new surgical methods begin on human cadavers (bodies preserved for scientific study). After the anchor is put in the cadaver, the arm is moved thousands of times. This mimics the number of times a shoulder would move during a typical six-week rehabilitation program.
Once this proves successful, the same process is repeated on live pigs. Then human trials begin. Human subjects are carefully followed for at least a year. So far, there have been very few problems. Occasionally, the anchors move or pull out of the bone, and sometimes the stitches break. Overall, however, the anchors hold up very well.
Doctors are beginning to use anchoring devices to button down the soft tissues of the torn rotator cuff. The most successful type of anchor button is made of bone. This anchor holds well and blends in with the original bone in less than six months. With very few complications and impressive results, this new approach to rotator cuff repair looks promising.
Peter M. Bonutti, MD, et al. Use of an Allograft Bone Button for Rotator Cuff Repair. In Orthopedics. February 2002. Vol. 25. No. 2. Pp. 149-703.
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