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What is Bioinductive Collagen Rotator Cuff Repair?

Bioinductive collagen rotator cuff repair is a surgical procedure to treat rotator cuff tears of the shoulder using collagen-based bioinductive implant or graft material that is the size of a stamp. It is a bioabsorbable implant that provides a coating of collagen over the injured rotator cuff tendons to facilitate early healing.

The rotator cuff is a group of tendons in the shoulder joint providing support and enabling a wide range of motion. A major injury to any of these tendons may result in a tear. This can occur with repeated overhead use of the arm, while playing sports, or due to age-related wear and tear. A rotator cuff tear is one of the most common causes of shoulder pain in athletes and middle-aged adults and older individuals, and results in weakness of the arm and restricted range of motion.

Bioinductive collagen implant is obtained from a highly purified bovine tendon. The implant is comprised of type 1 collagen and is an advanced healing solution for biological enhancement and tendon regeneration across all types of rotator cuff tears. This implant has growth factors that help regenerate the healing process. The procedure involves securely placing the implant over the site of the rotator cuff injury or tear to induce a healing response and support new tendon growth. The procedure helps in reducing the risk of re-tears and degeneration as well.

Anatomy of the Shoulder

The shoulder joint, also referred to as the glenohumeral joint, is a ball-and-socket joint made up of three bones, namely the humerus (upper arm bone), scapula (shoulder blade), and clavicle (collarbone). The head of the humerus articulates with the socket of the scapula called the glenoid cavity. The collarbone is an S-shaped bone that connects the scapula to the sternum or breastbone. Tendons and ligaments around the shoulder joint provide strength and stability to the joint.

Indications for Bioinductive Collagen Rotator Cuff Repair

Bioinductive collagen rotator cuff repair is indicated in patients with a symptomatic rotator cuff tear in whom conservative or nonsurgical treatment has failed to resolve or mitigate symptoms of rotator cuff tear. The most common symptom of a rotator cuff tear is pain that is usually over the outer and front portions of the shoulder. The pain usually worsens with shoulder movement.

In general, your doctor may recommend bioinductive collagen rotator cuff repair in the following scenarios:

  • You have full-thickness rotator cuff tears
  • You have significant pain, loss of function, and weakness in your shoulder
  • You are an athlete and wish to return to sports soon
  • Your symptoms have lasted for more than 6 months without much relief
  • Non-surgical treatments have failed to alleviate symptoms

Preparation for Bioinductive Collagen Rotator Cuff Repair

Preparation for bioinductive collagen rotator cuff repair may involve the following steps:

  • A review of your medical history and a physical examination are performed by your doctor to check for any medical issues that need to be addressed prior to surgery.
  • Diagnostic tests such as blood work to help detect any abnormalities that could compromise the safety of the procedure and imaging such as a CT and MRI scans are also performed to assess the size of the tear, retraction of the tendons, and degenerative status of the muscles and tendons supporting the shoulder joint.
  • You will be asked if you have allergies to medications, anesthesia, or latex.
  • You should disclose your current medications or supplements you are taking or any current illnesses or conditions you have such as heart or lung disease.
  • You may be asked to stop taking certain medications, such as blood thinners, anti-inflammatories, aspirin, or other supplements for a week or two.
  • You should refrain from alcohol and tobacco at least a few days prior to surgery and several weeks after, as it can hinder the healing process.
  • You should not consume any solids or liquids at least 8 hours prior to surgery.
  • You should arrange for someone to drive you home after surgery.
  • A signed informed consent form will be obtained from you after the pros and cons of the surgery have been explained.

Procedure for Bioinductive Collagen Rotator Cuff Repair

Bioinductive collagen rotator cuff repair surgery is usually performed using a minimally invasive arthroscopic technique under general or regional anesthesia and involves the following steps:

  • You will be placed on the procedure table in a beach chair or lateral decubitus position.
  • The skin around the shoulder joint is cleaned with an antiseptic solution, and two to three small incisions (arthroscopic portals), about a half-inch in length, are made over your shoulder joint.
  • An arthroscope, a slender tubular device fitted with a light and small video camera, is inserted through one of the incisions into your shoulder joint.
  • The video camera transmits the image of the inside of your shoulder joint onto a monitor for your surgeon to determine the gravity of rotator cuff damage.
  • Miniature surgical instruments are inserted through the other incisions to remove the damaged part of the rotator cuff tendon and injured surrounding tissue.
  • A collagen-based bioinductive implant is then delivered through a portal arthroscopically over the location of your rotator cuff tendon tear/injury and secured in place using suture anchors.
  • The implant stimulates the formation of fresh tendinous tissue over the surface of the rotator cuff tendon, resulting in a thicker tendon. It is the only implant of its type to induce new tissue growth to help tendons heal faster.
  • Your surgeon may also carry out any other repair if needed, and after adequate repair has been achieved, the scope and the instruments are withdrawn.
  • The tiny incisions are then closed with stitches or small sterile bandage strips.

Post-Operative Care and Recovery

In general, postoperative care and recovery after bioinductive collagen rotator cuff repair will involve the following steps:

  • You will be transferred to the recovery area where your nurse will closely observe you for any allergic/anesthetic reactions and monitor your vital signs.
  • Following the surgery, your arm will be placed in a shoulder sling for 2 to 4 weeks to rest the shoulder and promote healing.
  • You may experience pain, swelling, and discomfort in the shoulder area. Pain and anti-inflammatory medications are provided as needed to address these.
  • You may also apply ice packs on the shoulder area to help reduce swelling and pain.
  • You are encouraged to move around in bed and walk as frequently as possible to prevent the risk of blood clots.
  • Instructions on incision site care and bathing will be provided to keep the wound clean and dry.
  • Refrain from strenuous activities and lifting heavy weights for at least a couple of months. A gradual increase in activities is recommended with your physician’s guidance.
  • An individualized physical therapy protocol will be designed to help strengthen your shoulder muscles and optimize shoulder function once you are off the sling.
  • You should be able to resume your normal daily activities in 3 to 4 weeks but with certain activity restrictions. Return to sports may take 6 months or longer.
  • Refrain from driving until you are fully fit and receive your doctor’s consent.
  • A periodic follow-up appointment will be scheduled to monitor your progress.

Risks and Complications

Bioinductive collagen rotator cuff repair is a relatively safe procedure; however, as with any surgery, some risks and complications may occur, such as the following:

  • Infection
  • Re-tear
  • Postoperative pain
  • Bleeding or hematoma
  • Damage to surrounding structures
  • Shoulder stiffness or restricted motion
  • Thromboembolism or blood clots
  • Shoulder instability
  • Adverse reactions to anesthesia/allergic reactions

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