Biomedical Engineering Reference
In-Depth Information
Chapter 12
Soft Tissue to Bone Healing in Rotator
Cuff Repair
Leesa M. Galatz
12.1
Introduction
Tears of the rotator cuff tendons from their bony insertions are an extremely
important clinical problem. Rotator cuff disease is one of the most common
musculoskeletal disorders. In the United States, approximately 200,000 surgeries
per year are performed for rotator cuff tears and nearly 400,000 surgeries per year
are performed for rotator cuff tendinitis or partial rotator cuff tears [
1
]. Millions of
individuals are at risk for developing pain and disability secondary to rotator cuff-
related pathology. A recent analysis of cadaveric studies of rotator cuff tears
revealed a 30% prevalence of tears [
2
]. While the majority of tears are degenerative,
resulting from attritional changes in the tendon leading to attenuation, many occur
in traumatic settings as well.
Although rotator cuff repair is a common procedure in the orthopaedic setting,
healing of the tendons to bone after surgical repair is unpredictable, with failure rates
ranging from 20 to 94% [
3
-
5
]. Healing in the adult setting is a reparative rather than
a regenerative process, occurring via scar formation; the resultant tissue has signifi-
cantly lower structural and material properties compared to native, uninjured
tendon. Recently, innovations have been implemented to improve the strength of
the repair and to biologically augment the healing process. The purpose of this
chapter is to review the normal anatomy of the rotator cuff and its insertion site, to
discuss the factors affecting tendon healing and to highlight recent strategies for
improving healing of the injured rotator cuff.
L.M. Galatz (
*
)
Department of Orthopaedic Surgery, Washington University, 660 South Euclid,
Box 8233, St. Louis, MO 63110, USA
e-mail:
galatzl@wudosis.wustl.edu
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