An implant made from the Achilles heel of a cow is being used by NHS surgeons to repair debilitating torn shoulder muscles, restoring movement to paralysed arms in just a fortnight.
The experimental patch is stapled over the damaged tissue, providing support while stimulating the body’s healing response.
One of the first British patients to benefit, who underwent the procedure in March, says she’s now ‘back playing golf’.
Louisa Maguire, 68, from Cheshire, had been suffering increasing pain for years due to a small yet growing tear in her rotator cuff, the group of four muscless that surrounds the shoulder joint and supports arm movement. Now, four months after the surgery, she says: ‘It feels like I have a new shoulder.’
In a small study of 23 patients with recurrent shoulder injuries, 21 of them regained full mobility and were pain-free a year after having the operation.
An implant made from the Achilles heel of a cow is being used by NHS surgeons to repair debilitating torn shoulder muscles, restoring movement to paralysed arms in just a fortnight
The postage stamp-sized implant was approved for NHS use earlier this year. While new to the UK, thousands of patients in the US have undergone the procedure.
A third of adults aged over 50 develop rotator cuff tears, in which the fibrous tendons that anchor the muscles of the rotator cuff to the shoulder bones fray, and can even detach completely.
Common causes include repetitive arm movements – sportspeople and construction workers are often at risk – but the damage can be done simply by reaching up to a high shelf or pulling open a heavy door.
The muscles and tendons, particularly within the shoulders, stiffen with age, making tears more likely. Rotator cuff injuries are a very common reason for a visit to the GP. The majority are small partial tears, which can be treated simply with rest and ibuprofen.
MARIAM AL ROUBI: How to do squats safely
Squats are a standard leg strengthening exercise, but they can be so much more, too, depending on how you do them
Squats are a standard leg strengthening exercise, but they can be so much more, too, depending on how you do them.
By managing a deep squat, you’re helping hip, knee and ankle flexibility, and lower-back mobility. Doing them safely is key, however.
A good way to ease into the position and maintain good posture is to hold on to something – a bannister or garden gate, for instance.
Follow these simple steps.
- Stand about a foot away from your support, with feet a little wider than hip width and toes pointing outward very slightly.
- Using the support for balance, start to bend at the knees, pushing the hips back, and squat down – imagine you’re sitting down on a chair. Keep your back straight, chest up and face forward.
- Go down to where you’re comfortable and, leaning back slightly for stability, stay there for five to ten seconds, before coming back up. Use the support as much as you need to.
- Try repeating five times, and each time aim to get a little lower. The goal is to one day get to a full squat – with your bottom by your heels. Once there, you can gently rock from side to side to give your hips an extra stretch.
However, once a tear occurs, they tend to worsen – 80 per cent get larger within two years, according to studies, and can even cause the arm to become almost paralysed.
Previously, patients with severe tears would have surgery to pin the tendon back to the bone. But these procedures have had limited success, with 40 per cent of the nearly 50,000 patients who undergo surgery every year returning to their doctor with repeat problems.
Chris Peach, consultant shoulder and elbow surgeon at the OrthTeam Centre in Manchester, claims that while the older operation remedied the immediate problem, it did nothing to strengthen the muscle and prevent tears from recurring. He says: ‘Simply pinning damaged tissue back to the bone won’t solve the problem long term.’
The new patch is a ‘bio-implant’, derived from ‘purified bovine Achilles tendon’ – the tough tissue in the heel of a cow. It contains collagen – a protein in human and animal tissue vital for elasticity within tissues. During the healing process, the patch merges with the patient’s own rotator cuff, creating an extra layer of support for the recovering area as it heals.
The implant’s makers also claim it stimulates new, stronger tissue growth, making subsequent injuries less likely.
Louisa Maguire doesn’t remember exactly when or how she first injured her shoulder, but the pain had become so severe that even simple housework became impossible. ‘I used to enjoy playing golf, but as the pain got worse and worse even holding the club became impossible,’ she says.
She sought the help of Mr Peach, who recommended the new implant, called Regeneten, which has been developed by British medical manufacturing firm Smith & Nephew.
The 60-minute keyhole procedure to fit the patch is carried out under general anaesthetic. First, a small half-inch incision is made in the skin above the site of the tear. Using delicate movements, the tendon is pinned back to the bone using a series of screws or pins and surgical thread.
The Regeneten patch is rolled up and inserted through the incision, before being unrolled over the damaged area, where it’s held in place by dissolvable staples. These are absorbed by the body after about six months, by which time the patch and shoulder have ‘meshed’ and the healing process is almost complete.
Ms Maguire was able to return home just hours after her operation with her arm supported in a sling. ‘After about two weeks, my arm felt fine without the sling,’ she adds.
While welcoming the new procedure, OrthTeam orthopaedic surgeon Matt Ravenscroft said that more research was needed before they could be sure it was a better option. He adds: ‘Animal implants, including pig tissue, have been used in the past. But there’s little evidence they’re superior to standard methods.’
Despite this, surgeon Chris Mr Peach is enthusiastic.
He says: ‘This is the most exciting advance in the field of rotator cuff surgery in my career and has the prospect of completely transforming patient outcomes.’