Weekend warriors and gardeners alike, listen up. There’s a new twist on arthroscopic surgery for torn rotator cuffs: the minimally invasive AutoCuff system by Opus Medical, an arthroscopic repair system that reattaches the rotator cuff to the bone.
Arthroscopic repair of the rotator cuff, which is made up of four muscles that surround the shoulder and allow it to move, already results in a shorter hospital stay, earlier rehabilitation and less scar tissue than conventional open surgery.
The AutoCuff system goes a step further by eliminating the technically challenging knot-tying task of securing the suture to the bone, said Dr. Jeffrey L. Visotsky, an orthopedic surgeon at the Illinois Bone and Joint Institute. Visotsky is among a few surgeons around the country using the AutoCuff system, which the Food and Drug Administration approved last August.
Everyday activities that involve repetitive overhead motion, such as washing windows or pruning, put many at risk for shoulder injuries. Every year, 300,000 people have surgery for rotator cuff injuries. Most occur after age 40. Ten to 20 percent of all repairs are done arthroscopically; the rest are done with open surgery. Larger repairs generally require open procedures.
In arthroscopic rotator cuff repair, the surgeon makes several small incisions and inserts a special camera attached to a long, thin telescope to see inside the shoulder. Knots normally are tied to secure the suture to the bone.
Tying tight, small knots in a closed space and keeping the sutures from tangling can be difficult, Visotsky said. In addition, knots can irritate the joint.
“Poor-quality knots lead to failed repairs or less-than-optimal repairs,” Visotsky explained. “We want to sew back the muscle and restore the anatomy to its original condition as much as possible.”
With the AutoCuff system, stitching is no longer a multistep, cumbersome procedure, he said. “The SmartStitch suturing device throws a rapid stitch directly into the tissue in perfect configuration that’s very stable and strong.”
With conventional arthroscopic surgery, each stitch requires 15 minutes for insertion. With the AutoCuff system, each stitch requires 5 to 8 minutes. Stitches also are less likely to pull out of the tissue and damage the tissue itself, he said. The next step is to link the suture to a strong anchor, the device that enters the bone. The anchor is like a molly bolt, because it expands in the bone.
“We can now secure the suture to the anchor in a gradual tension fashion,” Visotsky said. “If you do not like the position of the muscle, you can release the suture and start over.”
The anchor, called the Magnum Knotless Fixation Implant, cinches the suture and secures the rotator cuff to the bone. “The anchor is very strong, and there is no weak point in the system as with a knot,” Visotsky said.
He and his associates have done 80 to 100 AutoCuff repairs, he said.
“Results have been as good as previously and probably better. Patients appear to be happier and are moving slightly more rapidly through therapy.”
However, they don’t heal faster; the muscle still has to attach to the bone.
The AutoCuff procedure requires less time under anesthesia, so there is less risk of infection. Because there is less trauma to the tissue, patients may feel less pain after surgery and be able to start physical therapy sooner, according to Visotsky.
William Najdowski of Chicago used an exercise machine the wrong way and tore his rotator cuff last year. The 58-year-old then tried to lift packages and found he couldn’t use his arm from then on. He had the AutoCuff repair in May. Just 2 1/2 weeks later, he had full range of motion and was working on his strength.
“I can hardly see the incision,” he said. “I’m also sleeping like a baby,” uncommon after shoulder surgery.
Linda Rudd of Libertyville had her fourth rotator cuff surgery in March. It was her first using the AutoCuff system.
“This was the easiest procedure out of all four,” said Rudd, 56. “I was home from the hospital within six hours, took Vicodin that night, and that’s it. I’ve healed beautifully and feel wonderful. I have to pull myself back from doing things.”
The AutoCuff procedure may be cost effective, too, because it saves about 45 minutes of operating time over regular arthroscopic surgery, according to Visotsky. Also, patients usually go home the same day as surgery.
Still, it may not be the least-expensive option for repairing a rotator cuff.
“An open repair with no suture anchors and no arthroscopic equipment is probably the least expensive,” said Dr. Andrew Green, chief of shoulder and elbow surgery at Brown University Medical School in Providence, R.I. “Arthroscopy adds expense because it requires the use of disposable instruments. The device/anchor adds expense as well.”
Blue Cross and Blue Shield of Illinois, the state’s largest insurer, covers both open and arthroscopic repair of rotator cuff injuries, according to Tony Rau, the insurer’s director of public affairs. Arthroscopic repair costs about 3 percent more than the open procedure.
