Dr Michell Ruiz

Dr Michell Ruiz
Cirugía de hombro y del Manguito rotador

domingo, 5 de enero de 2014

A 'new' patch for rotator cuff repairs. Is this BBC news?

http://shoulderarthritis.blogspot.mx/2014/01/a-new-patch-for-rotator-cuff-repairs-is.html



Saturday, January 4, 2014

A 'new' patch for rotator cuff repairs. Is this BBC news?

Researchers in Oxford have developed a degradable implant which they say has huge potential to improve surgical success rates

This article by the BBC talks of the promise of a "protective patch, which wraps round soft tissue repairs" that will be trialled in patients with shoulder injuries.

The article reports that 10,000 shoulder repair operations are carried out each year in England and Wales and that figure has risen by 500% in the last decade. "But one in four procedures is not successful, because the tendon tears again."

This report is based on laboratory tests that have been encouraging, but clinical trials have yet to begin. The team claims, "We've used modern technology to produce very fine fibres which have the extraordinary ability to direct the way cells behave, and "wake up" tired and aging cells, and make them want to heal, whereas previously they weren't being made to want to heal. The material in the patch is degradable, and disappears after a few months."

While we're all for research in improving the currently suboptimal anatomical and clinical results of cuff repair, it seems a bit early to for the BBC to be proclaiming the promise of the 'degradable implant'. Here are some previous posts on attempts to improve the biology of tendon healing in cuff repair.

Platelet-leukocyte membrane
Platelet fibrin matrix
Platelet rich plasma

It has been proposed that Graft Jacket may be useful in this regard, but results of aclinical trial have yet to be reported. The trial started in 2007 and was to be completed in 2010. We'd be most interested if any of the readers know of a results report.

A terrific review of 'patches' is provided here from the Wrightington Upper Limb Unit - a must read!






Trials to begin on new degradable surgical implant

Kevin SeniorKevin Senior can lift his left arm, but not his right


Researchers in Oxford have developed a degradable implant which they say has huge potential to improve surgical success rates.
The protective patch, which wraps round soft tissue repairs, will be trialled in patients with shoulder injuries.
It is hoped in time this approach could help patients with other conditions including arthritis, hernias and heart defects.
The implant has been developed using a mix of modern and ancient technology.
Kevin Senior experiences pain every time he lifts his right arm. He has torn the tendons in his shoulder. Mr Senior, who is 59, is a plumbing engineer, so this gives him serious difficulties in his work.

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We've used modern technology to produce very fine fibres which have the extraordinary ability to direct the way cells behave”
Professor Andrew CarrUniversity of Oxford
Even combing his hair or shaving causes him problems.
He is looking forward to having an operation next year at Nuffield Orthopaedic Hospital in Oxford.
"It's very frustrating but obviously you've got to do the best you can. Hopefully when it's repaired I'll be able to do everything, but as it stands now, you just struggle on."
There are 10,000 of these shoulder repair operations carried out each year in England and Wales. The figure has risen by 500% in the last decade. But one in four procedures is not successful, because the tendon tears again.
The surgeon who will operate on Kevin Senior's shoulder, Professor Andrew Carr, has led a research project to improve the success rate and ensure a quicker recovery. This collaboration between the university and the hospital trust helps move ideas quickly from the lab to the clinic.
Professor Carr's team have developed a protective patch - an implant which wraps around the surgical repair, like a splint.
One side is made of resilient woven material, to help it withstand the stresses of movement after surgery.
The other side is made of thread spun a hundred times finer than human hair.
LoomA loom was used to help make the implant
Its surface encourages cells to grip and bond, as they would naturally in a much younger patient.
Ancient technology
Professor Carr says the results in laboratory tests have been encouraging, and they hope to start clinical trials in patients soon.
"We've used modern technology to produce very fine fibres which have the extraordinary ability to direct the way cells behave, and "wake up" tired and ageing cells, and make them want to heal, whereas previously they weren't being made to want to heal.
The material in the patch is degradable, and disappears after a few months. Professor Carr says this is important for patients in their 40s, 50s and 60s who want to get back to work and may well live for several decades.

Start Quote

Scientists may look very technological, but they are very fond of simplicity and crafts ”
Osnat Hakimi,University of Oxford
"Once the repair process has taken place we would rather not have a piece of foreign material sitting in someone's body for the rest of their lives, because experience has shown us that ultimately the body will respond and reject that tissue."
The project uses the best in modern and ancient technology. Alongside the humming, whirring and beeping of the latest laboratory gadgetry, is the click and snap of a manually operated wooden handloom - perfect for producing the patch's protective cover.
One of the team, Osnat Hakimi, says the loom enabled them to use small quantities of expensive fibre and investigate its properties.
"Scientists may look very technological, but they are very fond of simplicity and crafts. Using our hands is something we do a lot in the lab. So actually working with a handloom is something that went down quite well."
ImplantThe implant helps to bind the tissue repair
Less than 5% of government funding for medical research goes on surgery, but Professor Car

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