Using -Skin- to Repair Your Rotator Cuff?

Dr. Spero KarasThe rotator cuff is the group of muscles and tendons that serve to stabilize the shoulder. The rotator cuff plays a key role in upper body mobility and ability when it comes to daily activities and athletic participation. Unfortunately, injuries to the rotator cuff, and specifically rotator cuff tears, are among the most common conditions affecting the shoulder.

Traditionally, surgeons have treated severe rotator cuff tears in one of three ways: simply removing dead and inflammatory tissue and bone spurs; transferring a tendon from another part of the body to the rotator cuff; or using freeze-dried human tissue or animal grafts to replace the missing tissue.

Unfortunately, in many cases, those rotator cuff tear treatments have been inadequate. Removing the inflammatory tissue and bone spurs certainly helps with the pain, but does nothing to improve motion. Transferring a tendon causes a lot of pain and trauma for patients who have to undergo surgery on two different sites on the body and, what is more, these extensive procedures may result in excessive complications.

As an alternative treatment for rotator cuff tears, I began using human skin grafts to perform a procedure called the “Bridge Technique.” In this procedure, the graft is surgically attached from the deficient tendon to the bone, forming a “bridge” over the empty space that once was a healthy tendon. Preliminary results in a study using human skin grafts to repair severe tears to the rotator cuff show that patients’ mobility is improved and pain is decreased.

In order to determine how the graft held up in 15 of my patients who were nearly a year or more out from having the procedure, I used Magnetic Resonance Imaging (MRI) and Ultrasound. In doing so, I found that in almost all of those patients, there was substantial healing of the graft and no complications related to the graft itself. Additionally, one year after the operation, patients had significant improvements in range of motion and a significant decrease in pain.

It’s very encouraging that in the evaluation of our early outcomes, nearly every one of our patients in this small series had favorable results, and their quality of life has improved. Using human tissue that has been properly processed for safety and durability has thus far provided a reliable option for patients who have had few alternatives for treatment.

Candidates for this procedure must be non-smokers with an irreparable rotator cuff tear, minimal arthritis, no joint dislocation and have less than 50% atrophy of their involved rotator cuff muscles.

I’ve included a video below that discusses the Bridge Technique and rotator cuff tear repair via skin grafts in more detail. Take a few minutes to check it out, and if you have questions for me, leave them in the comments below!


About Spero Karas, MD:

Dr. Karas joined the Emory Orthopaedic & Spine Center on February 1, 2005. Prior to that he served as chief of the Shoulder Service, team physician, and director of the Orthopaedic Sports Medicine Fellowship at the University of North Carolina at Chapel Hill Department of Orthopaedics. In addition to his role as director of the Orthopaedic Sports Medicine Fellowship Program at Emory, he serves as a consulting team physician for Georgia Tech and Emory University Athletics. Dr. Spero Karas is also an associate professor in the Department of Orthopaedics at Emory University School of Medicine and head team physician for the Atlanta Falcons.

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