When I am explaining rotator cuff surgery to patients, one of the most common questions I get is, “How do you repair the tear?”
My answer typically involves an explanation of some basics about rotator cuff tears:
- The rotator cuff is a group of tendons. Tendons are tissues that connect muscles to bone.
- Rotator cuff tears are grouped into “partial” or “full” thickness categories
- Full thickness rotator cuff tears typically happen when the tendons detach from the bone.
This means that most repairs of full thickness tears involve the surgeon reattaching the tendon tissue to the bone.
Simple enough sounding.
But how do you attach a soft, pliable tissue like tendon to a hard surface like bone?
Repairing tendon tissue to tendon tissue is pretty straightforward. It’s a bit like sewing a hole in your pants.
Pass a stitch from one side of tendon to the other Tie the two together with secure knots. Let Mother Nature do her thing and voila! A good repair.
Repairing tendon tissue back to bone is more complex.
Traditionally, when rotator cuff repairs were done with larger, open approaches the solution was to create tunnels in the bone and pass stitches through the tendon and the bone tunnels.
This technique is still used. But since arthroscopic techniques were developed surgeons have employed a now, widespread technology called “anchors” to repair the tendon to bone.
Anchors are small devices, made of metal, plastic or bone-like material. They look like small bullets with wings or ridges, that help secure them in bone and an eyelet through which suture passes. The bullet shape helps them tunnel into bone.
When an anchor is buried into bone the sutures effectively come out of the bone and can then be passed through tendon tissue.
Once the surgeon passes the sutures through the torn tendon, he or she can throw a few knots and tie the tendon back down to the bone.
Anchors usually work very well. The complication rates with them are low. And they are used very commonly for many different problems.
Anchors are permanent implants for the most part. As long as they are buried in bone and that bone holds well, they typically stay for life.
Some common operations in which we use anchors are rotator cuff repair, labrum repair and capsule plication,