Orthobiologics in shoulder rotator cuff repair
Biologics in orthopedics is new and growing exponentially. At our practice, my surgeon and I performed our first rotator cuff repair using Smith and Nephew's RegenetenTM biologic inductive implant. "The REGENETEN Bioinductive Implant stimulates the body's natural healing response to support new tendon growth and disrupt disease progression. Derived from highly purified bovine Achilles tendon, it creates an environment that is conducive to healing."
Our patient is a 54 year old male found to have a 3.3 cm retracted supra and infraspinatus tendon tear after a fall off a motorcycle. There was concern that this tear would not be amenable to repair due to the retraction and fatty atrophy seen on MRI. He was brought to the operating room and found to have complete tears of both tendons with retraction and fibrillation indicating an acute on chronic tear.
Initially the tendon was repaired using marginal convergence sutures and side to side sutures. Then using two triple loaded anchors both the infraspinatus and supraspinatus tendons were repaired to a solid footprint. After examining the repair it was decided to use the Regeneten implant to augment the repair given the thinness of the tendon repaired anteriorly. The regeneten implant was deployed through a lateral portal and medially the implant was attached to the tendon using soft tissue anchors. Finally two bony anchors were placed laterally to attach the implant to the greater tuberosity.
The patient was placed in a sling and routine postoperative care was given. At the two week follow up appointment he was doing well and comfortable in his sling. Initial postoperative care is 6 weeks of pendulum exercises with re-evaluation at that time and advancement in range of motion.
I found our first experience using biologics in the operating room to be very interesting. Although it is my first experience using a biologic system, I found the regeneten system to be very user friendly and straightforward. The science behind the technology is interesting. It is being used for patients with small interstitial tears in conjunction with ASAD, in patients with high grade partial thickness tears instead of standard repairs and with patients with full thickness tears to augment standard repairs.
Chris Wheeler, PA-C, M.M.Sc.
Northeast Region (CT, MA, ME, NH, NJ, NY, PA, RI, VT)
Last edited Monday, August 6, 2018