An innovative device for rotator cuff repair surgery

Poster Title: An innovative device for rotator cuff repair surgery

Student: Madeline Rieker, Class of 2024

Faculty Mentor and Department: Christopher Tuohy, MD; Department of Orthopaedic Surgery and Rehabilitation

Funding Source: Department of Orthopaedic Surgery and Rehabilitation, Wake Forest School of Medicine

ABSTRACT

Background: Rotator cuff tears pose a significant clinical challenge that is inadequately addressed by current interventions. Currently, there is no “gold standard” surgical treatment to restore pre-injury function, and rotator cuff repair surgeries are associated with retear rates as high as 20-70%.[1] Poor outcomes are often associated with risk factors including large tear size, high degree of muscle atrophy, poor tendon quality, and inappropriate rehabilitation.[2] The Atrium Health Wake Forest Baptist Department of Orthopaedic Surgery and Rehabilitationshoulder research group has identified excessive repair tension as a significant risk factor for impaired rotator cuff function and poor clinical outcomes.[3] However, some amount of mechanical strain is required to improve molecular remodeling and osteointegration of the repaired tendon.[4] Thus, the surgeon must strive for ideal tension at the repair site. Currently, there is no commercially available device that allows the surgeon to determine the amount of intraoperative tension or set ideal repair tension. Wake Forest has developed a surgical device for determination of repair tensions. This study aims to use our device to quantify and test intraoperative rotator cuff repair tensions, as well as correlate repair tensions with clinical outcomes.

Hypothesis: Excessive repair tension during rotator cuff repair surgery will lead to decreased postoperative functional and radiological outcomes.

Methods: This study is designed to include patients with different classes of rotator cuff injury who require an arthroscopic repair surgery. Interactions and interventions will include pre-surgery evaluation, surgical repair, standardized physical therapy, and post-operative follow-up visits at 6 months, 1 year, and 2 years. Participants will undergo standard of care surgical procedures, however, during the surgery, the tension measurement device will be used to measure the amount of tension required for either anatomic or medialized repair. The amount of tension will be quantified, and anatomical details of the injury will be documented. Outcome measures will include physician measurements of range of motion and strength, ultrasound examinations, and patient outcome measures. Results will be analyzed using descriptive statistics, comparison between different repair tensions, and regression analysis to identify independent outcome predictors. Comparison between patients with different repair tensions will be performed using chi square tests, t-tests, or ANOVA, and other statistical analysis may be conducted as appropriate.

Future Directions: This study is ongoing and in the process of enrolling patients. Once underway, data collection will provide measurements of intraoperative repair tensions that can be correlated with postsurgical outcomes. Future directions might include comparison of repair tension between anatomic and medialized repairs, and effect of intraoperative patient positioning on repair tension. 

Source of mentor’s funding or other support that funded this research: Spark Award Grant

[1] Aurora A, McCarron J, Iannotti JP, Derwin K. Commercially available extracellular matrix materials for rotator cuff repairs: state of the art and future trends. J Shoulder Elbow Surg. 2007;16(5 Suppl):S171-178

[2] Oh JH, Kim SH, Ji HM, Jo KH, Bin SW, Gong HS. Prognostic factors affecting anatomic outcome of rotator cuff repair and correlation with functional outcome. Arthroscopy. 2009;25(1):30-39

[3] Mannava S, Plate JF, Tuohy CJ, Seyler TM, Whitlock PW, Curl WW, et al. The science of rotator cuff tears: translating animal models to clinical recommendations using simulation analysis. Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA. 2012

[4] Galatz LM, Charlton N, Das R, Kim HM, Havlioglu N, Thomopoulos S. Complete removal of load is detrimental to rotator cuff healing. J Shoulder Elbow Surg. 2009;18(5):669-675