healthmedicinet

• Knitted patch implant made from polyester used to treat chronic pain
• Created by orthopaedic surgeon and former Olympian Roger Hackney
• Operation has been successfully carried out on 50 patients
• Shoulder pain affects one in four, caused by rotator-cuff tear in 70% cases
  

By
Roger Dobson

Published:

16:02 EST, 12 April 2014

|
Updated:

16:02 EST, 12 April 2014

A knitted patch made from drip-dry shirt material is being used to treat one of the most common causes of chronic pain.

The polyester implant has transformed repairs to torn shoulder  tendons. The patch is stitched in place over the rotator cuff, the muscle that allows the arm to raise.

Once in place, the patient’s own tissue grows in and around the patch to seal it permanently in place, and also to prevent any more tears.

Invented by consultant orthopaedic surgeon Roger Hackney, a former Olympic steeplechaser, the 40-minute operation has been carried out on about 50 patients with very large tears – alleviating pain and restoring movement.

Mr Hackney, who reached the  final of the 3,000m at the 1984 Los Angeles Olympics, explains: ‘What to do with these patients was an unsolved surgical problem. It was awful having to tell them there was nothing else we could offer when they had lost the use of the shoulder, and were in severe pain.

‘These patients have considerable problems. They could not put their arm over their head, they had a shoulder that didn’t work, were in pain, particularly at night, and it affected their quality of life and their working life.’

He teamed up with Leeds-based Neoligaments, part of the medical device company Xiros, to develop and produce the patch.

Shoulder pain affects up to a quarter of adults at some time, with about 70 per cent due to rotator- cuff tears.

Roger Hackney (left, 104) has invented the novel implant. The orthopedic surgeon is also a former Olympian

Prevalence increases with age, rising to three-quarters of the over-70s, although in many cases it does not result in serious symptoms.

The shoulder joint is a ball-and-shallow-socket assembly and is covered by the rotator cuff, a group of four muscles and their tendons which keep the joint stable and drive shoulder movement.

Most rotator-cuff tears are caused by repetitive overhead arm movement. Swimming, weightlifting, painting or window-cleaning can also increase the likelihood of shoulder pain associated with poor rotator-cuff function.

The tear is a coming away of the attachment of the tendon to the bone of the top end of the arm. It can also be caused by trauma, such as a fall or dislocation.

Symptoms of a tear include significant pain at night, with an inability to lie on the affected side, loss  of overhead movement, muscle weakness, and difficulty dressing and undressing.

Where the tear is relatively small – less than 3cm – it can be surgically repaired by bringing the tendon to the bone, then stitching and anchoring the soft tissue of the cuff in place. But sometimes the tear is simply too large and stiff and cannot be stretched to the bone, making bigger tear repairs difficult.

Those greater than 5cm in diameter are not always repairable and gaps are left, leading to the tear returning with time.

An added complication is that with advancing age, the tendons and muscles can deteriorate, making them unsuitable for stretching and stitching.

Mr Hackney, consultant surgeon at Leeds General Infirmary and Honorary Senior Lecturer at the University of Leeds, came up with the idea of the patch after being unable to offer a suitable treatment to his patients.

The patch he developed is a woven polyester fabric. It is implanted using open surgery and a general anaesthetic, and is stitched into place over a repair of the torn rotator cuff.

Shoulder pain affects up to a quarter of adults at some time, with about 70 per cent due to rotator-cuff tears

Once in place, the patch, which comes in three sizes from 3cm to 5cm, reinforces the tissue and prevents future tears. It also reduces the load on the tissue.

A key design feature is that its structure encourages the growth of the patient’s own tissue into the patch material.

Early data shows that the patch, which has now been approved for use in the UK and Europe, has been particularly successful in patients whose tendon tears have recurred after a normal repair, and in patients where a normal repair is not possible because the tendon is too stiff and the muscle wasted.

Lee Richardson, a Leeds-based joiner and builder, had a patch implanted in his right shoulder  and is now waiting for surgery on his left.

‘I had a tear on the right side and it was very painful, especially when  I lifted my arm above my head,’ says Lee, 48.

‘After the patch was put on, the pain pretty much went away. I get the occasional twinge with movement, but considering that the  tear was 5cm long, that’s pretty good. I was very pleased with  the outcome.

‘I think the problem began when I fell over playing football years ago, but with age it got worse.
‘The work involved in my job didn’t help either. The left shoulder has now gone, and I am waiting for a date for the next surgery.’

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