MedStar Health News

Patients with irreparable rotator cuff tears have new option with subacromial spacer

BALTIMORE - MedStar Health has become the first health system in the greater Baltimore region to offer patients with massive, irreparable rotator cuff tears, a new arthroscopic approach using a balloon spacer device to cushion the shoulder socket after a rotator cuff tear. On Monday November 29, 2021, Dr. Anand Murthi treated a 65-year-old woman with the procedure that was performed in less than two hours. The patient went home the same day.

Dr. Murthi inserted the balloon device into the subacromial space located in the shoulder between the upper shoulder bone and the ball-and-socket joint underneath and filled it with saline. The implant mimics the fluid-filled bursa, the natural cushion in the shoulder, which becomes enflamed and painful after a tear.

Almost two million people visit doctors’ offices because of torn rotator cuff injuries, which most commonly occur in the dominant arm and are one of the most common sports medicine injuries.
“Athletes are at particular risk for a rotator cuff injury,” said Dr. Murthi, director of shoulder and elbow-surgery for the MedStar Orthopaedic Institute at MedStar Union Memorial Hospital. “But it can affect anyone whose job or activities require a repetitive overhead motion.”

The inflatable device has been used to treat over 29,000 severe rotator cuff tears over the past ten years in Europe, but it has only been approved by the federal Food and Drug Administration in the U.S. last summer. It’s recommended for patients over 65 who have suffered large, irreparable tears where the tendon has torn and retracted, or whose tear would be impossible to reconnected to the head of the upper arm's humerus bone.

Patients experience pain relief with this approach because the balloon blocks the humeral head from rubbing with the acromion and forces the humeral head in a more natural position and improves the joint motion.

The biodegradable balloon will be resorbed in the body over time, giving patients time to heal and strengthen muscles around the injured rotator cuff.

“Sometimes patients over 65 with degenerated bone conditions are poor candidates for the standard reattachment surgery for repairing rotator cuff tears. The surgery and the recovery both are challenging,” Dr. Murthi said.

“Current strategies treating massive irreparable rotator cuff tears often present a challenge to surgeons and may require a long and frustrating recovery,” Dr. Murthi added. This new device uses a biodegradable implant which makes me very proud to be able to offer it to our patients. Only a small opening is made to implant it, using a long arthroscopic tube, scope so the recovery is much easier.”

One-Step Prep and Surgical Advantages Mean Streamlined Procedure, Less Time Under Anesthesia

BALTIMORE- Using a new fully integrated shoulder arthroplasty system, Dr. Anand Murthi, chief of shoulder and elbow surgery at MedStar Union Memorial Hospital and professor of orthopaedic surgery, became the first surgeon in the U.S. to implant the innovative Depuy Inhance shoulder system during a shoulder replacement procedure last week. The implant, which Dr. Murthi helped to design, was used to replace the arthritic joint of a 65-year old man.

A surge in the geriatric population with advancements in technical approaches in surgery and improvements in devices, account for a trending increase in the frequency of shoulder arthroplasty, or shoulder replacement. Industry data shows that shoulder replacements are the fastest growing orthopedic joint replacement surgery in the country, tallying nearly 70,000 annually.

During a shoulder replacement procedure, the ball section of the joint, or the socket part, is replaced using a prosthesis made of polyethylene and metal components. There are different approaches to performing a shoulder arthroplasty including a partial, total, a revision, or a reverse shoulder replacement.

The Inhance shoulder system was designed by surgeons and engineers using an intuitive approach to patient care with consideration to the multiple reasons why it may become necessary during surgery to change from one approach option to another. It’s the first shoulder system to allow a seamless transition from stemless to stemmed to reverse shoulder implants if necessary. Humeral bone quality, severe glenoid bone loss and damage to the rotator cuff may lead the surgeon to opt from performing a standard shoulder replacement to a reverse shoulder replacement.

“This is really a leap forward in advancing the technology to replace the shoulder joint,” explained Dr. Murthi, “the intelligent system design means simultaneous steps can take place to prepare the bone and thereby reducing the length of the surgery. That means the patient is under anesthesia for less time.”

Last week, the total shoulder replacement procedure took under 1.5 hours. The patient went home the same day using regional anesthesia.

The new shoulder system also has unique intraoperative flexibility. It features a comprehensive size range of anatomic stemless and stemmed inlay humeral implants that share a common geometrical shape to easily fixate to the humerus. The innovative zoned-conforming glenoid, with one-step preparation is novel to the shoulder market. Dr. Murthi and his research team published on this in the Journal of Bone and Joint Surgery.

The implants are manufactured via state-of-the-art 3D laser and manufactured using an advanced cross-linked Vitamin E polyethylene for its wear characteristics and oxidative stability. This is important to reducing the risk of revision and complications.

BALTIMORE—Dr. Richard Levine became the first surgeon in a U.S. multi-center study to use the Bridge-Enhanced® ACL Repair (BEAR®) Implant for the treatment of an anterior cruciate ligament (ACL) tear, when he implanted the bio-engineered replacement in a 32-year-old male. Performed at MedStar Surgery Center at Timonium, an outpatient site affiliated with Medstar Union Memorial Hospital, the patient went home the same day.

ACL tears are one of the most common knee injuries in the nation. The BEAR Implant is the first medical technology to clinically demonstrate that it enables healing – or restoration – of the patient’s torn ACL. The approach is a paradigm shift from the current standard of care – reconstruction that replaces the ACL with a graft – and is the first innovation in ACL tear treatment in more than 30 years.

Every year, approximately 400,000 ACL injuries occur in the United States. A torn ACL does not heal without treatment, resulting in ACL reconstruction being one of the most common orthopedic procedures in the U.S. The ACL is a ligament stretching from the front to the back of the knee and is part of the tissue connecting the thigh bone to the shinbone. Tears to the ACL most often occur in athletes during a fast pivot motion, changing direction or stopping suddenly, or when landing a jump.

“We have historically defined success of ACL reconstruction as restoration of knee stability, however patients who have received this treatment have a high risk of developing degenerative arthritis as they age” said Dr. Levine, a MedStar Health orthopaedic sports medicine surgeon and principal investigator for the study. “Preliminary studies using the BEAR implant have yielded similar success rates in terms of restoring knee stability in addition to laboratory studies that have shown a significant decrease in the rate of knee degeneration. As one of the largest sports medicine providers in the country, we are very excited to be able to offer this to qualified patients.”

During an ACL reconstruction, the surgeon completely removes the remaining torn ACL and most often reconstructs it with a tendon from the patient’s own leg (called an autograft). Unlike reconstruction, the BEAR procedure does not have the morbidity of a graft harvest. The BEAR Implant acts as a bridge between the two ends of the torn ACL. The surgeon injects a small amount of the patient’s own blood into the implant and inserts it between the torn ends of the ACL in a minimally invasive procedure. The combination of the BEAR Implant and the patient’s blood enables the body to heal the torn ends of the ACL back together while maintaining the ACL’s original attachments to the femur and tibia.

About MedStar Health
At MedStar Health, we use the best of our minds and the best of our hearts to serve our patients, those who care for them, and our communities. Our 30,000 associates and 4,700 affiliated physicians are committed to living this promise through our core SPIRIT values—Service, Patient first, Integrity, Respect, Innovation, and Teamwork—across our more than 300 locations including 10 hospitals, ambulatory, and urgent care centers. As the medical education and clinical partner of Georgetown University, MedStar Health is training future physician leaders to care for the whole person and is advancing care through the MedStar Health Research Institute. From our telemedicine and urgent care services to the region’s largest home health agency, we’re committed to providing high-quality health care that’s also easy and convenient for our patients. At MedStar Health—It’s how we treat people. Learn more at MedStarHealth.org.