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Shoulder AnatomyLearn More
Shoulder InstabilityLearn More
Rotator Cuff TearsLearn More
Arthroscopic Rotator Cuff RepairLearn More
REGENETEN Bioinductive ImplantLearn More

Shoulder anatomy

The shoulder is a ball-and-socket joint and has the greatest range of motion of any joint in the body. Because of this mobility, it is at risk for injury or degenerative problems. The bones of the shoulder are the humerus (upper arm bone), clavicle (collar bone), and scapula (shoulder blade). The head of the humerus bone (the ball) is lined with cartilage that glides over the shoulder socket (also known as the "glenoid cavity"). The clavicle attaches the shoulder to the rib cage and holds the shoulder out from the body. The scapula is a large triangular bone located on the back side of the upper body, and it is connected to the clavicle through the acromioclavicular (AC) joint.

In the shoulder socket, the humerus sits like a golf ball on a tee, supported by a complicated arrangement of muscles, tendons, and ligaments. The rotator cuff is a group of tendons that attaches four shoulder muscles to the upper arm. These tendons help keep the humerus bone in place within its shallow socket and ensure that the arm moves freely within the joint.

All information provided on this website is for information purposes only. Every patient's case is unique and each patient should follow his or her doctor's specific instructions. Please discuss nutrition, medication and treatment options with your doctor to make sure you are getting the proper care for your particular situation. If you are seeking this information in an emergency situation, please call 911 and seek emergency help.

Shoulder instability

Shoulder instability occurs when the structures that surround the shoulder joint loosen and cannot maintain the ball within its shallow socket. If the joint is too loose, it may slide partially out of place, a condition known as "shoulder subluxation."

When the joint comes completely out of place, also called "shoulder dislocation", the ligaments that support the shoulder are torn. Normally, this injury does not heal tightly, making the shoulder prone to repeat dislocation and additional episodes of instability.

With shoulder instability, some activities can create sudden pain, a sense of arm deadness, or the feeling of your shoulder slipping out and back into the joint. If you experience complete dislocation, you may have severe pain along with the inability to "reset" the joint.

Some shoulder instability can be treated with rest followed by rehabilitation. However, in certain instances, the physician may recommend surgery - these include more complicated injuries, cases of recurrent instability, and first-time dislocations in younger patients who have a high risk of recurrence, further damage, or limited activity.

Rotator cuff tear

Our rotator cuff can weaken as we age, and increase our likelihood of a rotator cuff tear. Repeated use of your arms in daily activities we take for granted can accelerate weakening and possible tearing. This is especially true in adults over the age of 40. If your job requires you to reach overhead, such as painting, carpentry, stocking shelves, or other vertical reach work, you may develop tendonitis. Tendonitis can become worse and lead to tearing of the tendons of the rotator cuff.

Rotator cuff tears aren't limited to work injuries; sports and activities with repetitive motions involving overhead reach - tennis, swimming, softball and baseball - can lead to weakening and tearing. Trauma from falls can also cause a tear.

Rotator cuff tears typically cause pain on the top and anterior, or front, of your shoulder. You may also feel pain on the side of the shoulder, and you may notice the pain increasing with overhead reach activities. Increased tears weaken your muscles and prevent daily activities like brushing hair and putting away dishes in cabinets painful. Your shoulder may also stiffen because of this non-use and continue to stiffen as you postpone activity above shoulder level.

You may hear popping or crackling sounds caused by the tears. This is a result of bursitis, the inflammation of the fluid sac that surrounds the shoulder joint. Your tear may rub and case this sensation and can cause difficulty sleeping if you put pressure on your shoulder.

Rotator cuff tears can respond to many types of treatments, and arthroscopic surgery options provide minimally invasive options to help restore your range of motion and let you get back to your quality of life.

Arthroscopic rotator cuff repair

What is arthroscopic rotator cuff repair?

Arthroscopic rotator cuff repair is performed to treat tears in the rotator cuff tendon. Your surgeon may recommend this procedure if conservative treatments have no effect. The procedure varies depending on the severity of the tear, but usually involves the reattachment of the torn tendon to the humerus, or upper arm bone. The procedure is performed as minimally invasive as possible, but if the tear is very severe, part of the procedure may have to be performed as open surgery.

Who needs this procedure?

The rotator cuff is made of muscles and tendons that come together to cover the head of the humerus. These tendons attach the humerus to the shoulder blade and plays a large part in your ability to lift and rotate your arm. Symptoms of rotator cuff tears vary depending on the severity of the injury, which can occur from trauma, injury, or from natural degeneration of the tendon. Rotator cuff injury is very common and very painful. People who work or perform in a manner that requires repetitive stress on the rotator cuff tendons, like those who do work that requires extensive arm lifting, and anyone over the age of 40 could potentially suffer from a rotator cuff tear. Symptoms include arm weakness or pain when lifting, making specific movements, or rotating the arm, pain when resting on the affected shoulder, and a crackling sensation in the shoulder when performing certain movements. Pain from rotator cuff damage increases as time goes on.

Initial incisions and insertion of arthroscope

After anesthesia is applied, the surgeon make small incisions on the shoulder. A small camera called an arthroscope is inserted through one of the incisions. The surgeon uses the arthroscope for image guidance during the surgery. At this stage, the arthroscope is used to inspect the damaged joint.

Debridement

Using small tools inserted through the initial incisions, loose tendon fragments and other debris from the damaged tendon are removed in a process called debridement. The surgeon inspects the tissue damage to decide if more surgery is necessary.

Smoothing of acromion

The surgeon inserts a special tool into one of the incisions to remove bone spurs from the bottom of the acromion and smooth out its surface in a procedure called subacromial decompression. This is done to prevent the acromion from impinging on the supraspinatus tendon, which can be very painful.

Rotator cuff inspected

The surgeon may end the procedure here if no rotator cuff tears are present. If a tear is found in the rotator cuff tendon, method of repair will vary according to the size and severity of the tear. Arthroscopic repair, or repair made through the small incisions using special tools, may be made if the tears are small to moderate-sized. Large tears may require open surgery. The surgeon will start by cleaning the area of the tendon where the tear is present and clearing an area on the humerus.

Placement of anchors

The surgeon creates small holes in the cleared area of the humerus and places special tools called anchors into the holes. These will hold stitches in place.

The tendon is sutured

The surgeon then stitches the tear back together. The tendon is reattached to the humerus by pulling the sutures against the anchors placed in the previous step.

End of procedure

Instruments are removed, and the incisions are closed. The patient's arm may be placed in a sling.

After surgery

If the surgery is performed entirely arthroscopically, it will be an outpatient procedure. This means the patient may leave the hospital that day. Longer hospital time may be required if the tear requires open surgery to repair. Your doctor will prescribe physical therapy to help restore normal and pain-free mobility after the surgery. Recovery time varies depending on the severity of the initial injury and the patient's adherence to the physical therapy prescribed.

REGENETEN^◊ Bioinductive Implant

Your Physician is pioneering the use of a breakthrough technology designed for people suffering from rotator cuff tendon tears in the shoulder joint. The REGENETEN Bioinductive Implant, an innovative, minimally invasive solution, goes beyond traditional surgery to help the tendon heal through the induction of new tendinous tissue growth^1,2,3.

A new approach - REGENETEN Bioinductive Implant

Until now, surgeons have focused on addressing the mechanics of the shoulder when repairing a rotator cuff injury, but had limited options to address the biology of healing. Traditional rotator cuff repair procedures involve suturing tendon to bone are associated with potentially long rehabilitation and substantial lifestyle interruption. As a result, many people choose to forego surgery until their pain is severe and everyday tasks are affected. However, as rotator cuff disease progresses, it can become increasingly difficult for your surgeon to repair and small tears can grow in severity and size over time ^4,5,6.

The REGENETEN Bioinductive Implant is an innovative technology designed to address the treatment of rotator cuff disease

The REGENETEN Bioinductive Implant offers a new solution that supports the body's natural healing response to facilitate new tissue growth and potentially disrupt disease progression ^1,2,7-9 by providing a framework for tissue growth.

What is it?

The technology includes a collagen based bioinductive implant about the size of a postage stamp. This implant is delivered arthroscopically through a small incision over the location of your rotator cuff tendon injury. Your physician will secure it in place with small anchors.

How does it work?

Progression of healing

The implant is placed on top of the rotator cuff After implantation, the REGENETEN Bioinductive implant creates an environment that is conducive to healing ^1,2,7 and the proprietary composition facilitates the formation of new tissue ^1,2,7,10.

The implant induces new tissue growth, increasing tendon thickness ^1,2,3.
New tissue allows tendon to restore its natural attachment points in the body³ and is indistinguishable from native tendon at 3 months ^1,2,11.

New tissue integrates and remodels into the healing tendon ^2,7,11 .
Tissue strength comes from the induced tissue, not the implant, which has been shown to be completed absorbed within six months ^{7,11, *}.

How does the REGENETEN Bioinductive Implant benefit you?

No matter where you are in the progression of rotator cuff disease, the REGENETEN Bioinductive Implant has shown consistent healing of rotator cuff tears in both partial and full thickness tears ^1,2,8,12.

Preliminary evidence indicates a reduction in re-tear rates compared to the standard of care in patients with full thickness tears ^3,13
No tear progression was observed by MRI in any patients at 24 months in a study on partial thickness tears (n=13) ¹
Clinically meaningful improvements in pain and function scores at one year compared to pre-operation values ^14,15
Excellent safety profile shows there have been no serious implant-related adverse events reported in the published literature ^1-3,7,12

References

Bokor DJ, Sonnabend D, Deady L, et al. Evidence of healing of partial-thickness rotator cuff tears following arthroscopic augmentation with a collagen implant: a 2-year MRI follow-up. Muscles, Ligaments Tendons J 2016;6(1):16-25.
Schlegel TF, Abrams JS, Bushnell BD, Brock JL, Ho CP. Radiologic and clinical evaluation of a bioabsorbable collagen implant to treat partial-thickness tears: a prospective multicenter study. J Shoulder Elbow Surg. 2018 27(2):242-251.
Bokor DJ, Sonnabend D, Deady L, et al. Preliminary investigation of a biological augmentation of rotator cuff repairs using a collagen implant: a 2-year MRI follow-up. Muscles, Ligaments Tendons J 2015;5(3):144-150.
Henry P, Wasserstein D, Park S, et al. Arthroscopic repair for chronic massive rotator cuff tears: A systematic review. Arthroscopy. 2015;31(12):2472-80.
Bishop J, Klepps S, Lo IK, Bird J, Gladstone JN, Flatow EL. Cuff integrity after arthroscopic versus open rotator cuff repair: A prospective study. J Shoulder Elbow Surg. 2006;15(3):290-299.
Heuberer PR, Smolen D, Pauzenberger L et al. Longitudinal long-term magnetic resonance imaging and clinical follow-up after single-row arthroscopic rotator cuff repair. Am J Sports Med. 2017;45(6):1283-1288.
Van Kampen C, Arnoczky S, et al. Tissue-engineered augmentation of a rotator cuff tendon using a reconstituted collagen scaffold: a histological evaluation in sheep. Muscles, Ligaments Tendons J. 2013;3(3):229-235.
Bokor DJ, Sonnabend DH, et al. healing of partial thickness rotator cuff tears following arthroscopic augmentation with a highly porous collagen implant: a 5-year clinical and MRI follow-up. Muscles, Ligaments Tendons J 2019;9(3):338-347.
McElvany MD, McGoldrick, et al. Rotator cuff repair: published evidence on factors associated with repair integrity and clinical outcome. Am J Sports Med. 2015;43(2)491-500.
Smith + Nephew 2020 REGENETEN Collagen Implant Physical Characteristics. Internal Report
Arnoczky SP, Bishai SK, Schofield B, et al. Histologic Evaluation of Biopsy Specimens Obtained After Rotator Cuff Repair Augmented With a Highly Porous Collagen Implant. Arthroscopy. 2017;33(2):278-283.
Thon SG, O'Malley L, O'Brien MJ, Savoie FH. Evaluation of Healing Rates and Safety With a Bioinductive Collagen Patch for Large and Massive Rotator Cuff Tears: 2-Year Safety and Clinical Outcomes. Am J Sports Med 2019;47(8):1901-1908.
Smith and Nephew 2019. An overview of the outcomes associated with the standard of care for the surgical treatment of rotator cuff tears. Internal Report EO/SPM/REGENETEN/005/v1
McIntyre L, Bishai SK, et al. Patient-reported outcomes following use of a bioabsorbable collagen implant to treat partial and full-thickness rotator cuff tears. Arthroscopy. 201935(8):2262-2271.
Cvetanovich GL, Gowd AK, et al. Establishing clinically significant outcome after arthroscopic rotator cuff repair. J Shoulder Elbow Surg. 2019;28(5):939-948.