Seam-Like Transtendon Anchor Repair for Rotator Cuff Creep
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Solution Overview
Problem
Existing arthroscopic methods for repairing rotator cuff tears suffer from high failure rates due to non-anatomical tendon reattachment and insufficient anchor placement, leading to creases, gaps, and weak compression, which inhibit healing and cause cyclic creep, especially in large or massive tears.
Innovation Solution
A system of anchors implanted through the tendon (transtendon) forms a high-density, seam-like attachment with continuous anchor-to-anchor stitches, ensuring anatomical alignment and robust compression by using a single suture strand, allowing for multiple anchors in close proximity to maintain tendon-bone contact without micromotion.
Engineering Contradictions & Design Principles
Engineering Contradiction Analysis
1Ease of manufacture
If traditional arthroscopic methods are used for tendon reattachment, then the surgical procedure can be performed minimally invasively, but the tendon attachment becomes non-anatomical with creases and gaps, leading to high failure rates
Solution Approach 1:
The tendon attachment is divided into multiple discrete anchor points distributed across the footprint, with individual sutures tensioned and locked at each anchor. This segmentation allows precise anatomical reattachment at multiple locations while maintaining surgical feasibility through standardized anchor implantation procedures
Solution Approach 2:
Multiple anchors are implanted and sutures are pre-positioned through the tendon and bone before final tensioning and locking. This preliminary arrangement of attachment points enables anatomical precision to be achieved before the final securing step, resolving the contradiction between procedural simplicity and attachment precision
2Device complexity
If fewer anchors are used in traditional methods, then the device complexity and surgical time are reduced, but the compression force is insufficient, causing cyclic creep and attachment failure
Solution Approach 1:
The total compression force requirement is segmented across multiple anchors distributed throughout the tendon footprint. Each anchor contributes a portion of the total compression force, and the cumulative effect of many small forces achieves the necessary overall compression to prevent cyclic creep, while keeping individual anchor complexity low
Solution Approach 2:
Multiple individual anchor-suture systems are combined to work together as a unified attachment structure. The cumulative compression force from all anchors acts collectively on the tendon to maintain anatomical apposition and prevent creep, achieving high strength through combination rather than through complex individual components
3Ease of operation
If anchors are placed in traditional locations, then the surgical procedure is simpler, but the tendon attachment is non-anatomical, creating gaps and creases that inhibit healing
Solution Approach 1:
Each anchor is placed at a specific location within the tendon footprint to match the local anatomical requirements. The density and distribution of anchors vary according to the local tendon architecture and stress patterns, with higher density in areas requiring greater stability. This local customization achieves anatomical precision without requiring complex global surgical procedures
Solution Approach 2:
The optimal anchor locations are predetermined based on anatomical considerations, and anchors are implanted at these pre-planned positions before final tendon tensioning. This preliminary placement at anatomically correct locations ensures proper tendon footprint alignment is achieved before the final securing step, resolving the contradiction between surgical simplicity and anatomical accuracy
4Productivity
If the tendon is allowed to move relative to bone during healing, then the rehabilitation process is faster, but cyclic creep occurs, causing attachment failure
Solution Approach 1:
The multiple anchors are distributed in a pattern that follows the natural curvature of the tendon footprint on the bone. This curved arrangement of anchors matches the anatomical geometry, allowing the tendon to conform to the bone surface while maintaining stable attachment. The curved anchor pattern provides stability that permits early rehabilitation movements without causing cyclic creep at the interface
Data Source
AI summary
Methods and apparatus for creating a seam like array of suture stitches joined in series by sequential anchors in bone. The anchors are transtendon implants positioned through the tendon in the original tendon footprint and each array includes four or more anchors. The seam like array extends across at least a portion of the tendon. The stitches can extend generally perpendicular to the direction of the tendon orientation. In rotator cuff repair, the anchors are positioned in the original footprints of the infraspinatus and/or supraspinatus tendons and the seam like array extends in an anterior to posterior direction across the particular tendons torn and repaired. The entire array of anchors can be positioned in the medial half of the original footprints.