New Techniques Tackle Rotator-Cuff Injuries

The Wall Street Journal—NEW YORK—January 23, 2008

When it comes to joint injuries, rotator cuffs are the repeat offenders. Surgery can fix the debilitating shoulder problem, but as many as half of all patients retear their rotator cuff, often because of overzealous activity or the weakened quality of their tendon tissue after years of wear and tear.

Now doctors are using a number of new techniques to improve the outcome for rotator-cuff repair, including using double instead of single rows of sutures in the repair. They are also working with new materials - including those made from the patient's own blood - that can act as patches or scaffolds to support the repaired rotator cuff while the tissues heal. While new minimally invasive techniques are making the surgery easier on patients, recovery and rehabilitation can still be long and painful. To help, doctors are focusing on getting patients to better adhere to rehabilitation programs, which can take months.


David Altchek prepares to perform arthroscopic rotator-cuff repair surgery on a patient.

Between three million and four million patients annually see a physician for problems with the rotator cuff, the complex network of muscles and tendons that hold the shoulder in place and enable the arm to rotate. Injuries can be caused by accidents, repetitive use, a bone spur that saws away at muscle, or the aging process.
While many pulls and strains can be managed with physical therapy, anti-inflammatory medications or steroid injections, a torn rotator cuff can't heal on its own without surgery. As a result, chances of a more serious tear increases, leaving surgery as the only option. By some estimates the number of tears requiring surgery could more than double over the next several years to 500,000, as active baby boomers push the limits of their aging bodies.

When he first injured his rotator cuff in a ski injury a few years ago, Ron Baron wanted to avoid a recommended surgery, and found relief through physical therapy. But last summer, while testing some home-gym equipment, the 64-year-old New York fund manager felt a sharp twinge in his right shoulder. Later when he tried to hit a tennis ball, he crumpled in pain. After a scan showed that a tear had worsened, he decided to have the procedure last fall so he could maintain his active pursuits.

"There are still patients who say, 'OK, I'll give up golf or tennis rather than have the surgery,'" says David Altchek, the co-chief of Sports Medicine and Shoulder Service at New York's Hospital for Special Surgery, who operated on Mr. Baron and has seen the number of rotator-cuff surgeries he performs rise by 20% over the past few years. "But we are in a generational shift where more and more patients are simply not willing to give up their level of activity."

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