Torn shoulder? Patch it up with an implant made from pig skin

IMPLANTS made from pig skin may offer relief to thousands of Britons suffering long-term shoulder pain and weakness. The grafts, a biological mesh made from porcine collagen, can be used to replace torn tendons that were once deemed inoperable.

The structure of pig cells is similar to those of humans, meaning the patient’s body is unlikely to reject the donor tissue.

Until now the only surgical solution for the most severe tendon tears in the shoulder was a full shoulder replacement operation – a drastic option that saw many patients preferring to live with permanent discomfort, weakness and difficulty in raising their arm.

The shoulder, a ball-and-socket joint, is covered by layers of muscle and fibrous tissues known as tendons and ligaments which allow the arm a wide range of movement.

The innermost layer is the rotator cuff, a tough sheath that supports the arm at the shoulder joint, connecting the upper arm (humerus) to the shoulder blade (scapula).

Half of Britons over 60 suffer a partial rotator cuff rupture at some point, where a part of the tendon is still attached. About five per cent of these cases involve complete and inoperable ruptures.

The injury can occur as a result of sudden impact such as a fall, exhaustion through overuse, or weakening as people age.

In the case of partial tears, surgery involves stitching the tear back together and then reattaching it to the bone.

However, if the tear is complete, this has proved to be almost impossible. The Japanese inventors of the new grafting technique claim it improves strength and function by more than 80 per cent and provides pain relief.

‘Rotator cuff tears are very common,’ says consultant orthopaedic surgeon Mr Duncan Tennent, who started offering the reconstructive procedure in April last year and now treats patients privately at Spire St Anthony’s Hospital in Cheam, Surrey, and on the NHS at St George’s Hospital in London.

‘Many are surgically repairable, but some are too large and the options are very limited. This new procedure uses a graft made from tissue removed from a human donor or a pig to repair the torn tendon.

‘Because this procedure is arthroscopic or keyhole, there is minimal trauma, small scars and a much quicker recovery. It has very good results. It is currently being used for patients over 60, but it also gives a solution to younger patients with a massive irreparable tear, for whom I didn’t have an option before.’

With the patient under general anaesthetic, the surgeon first makes five 5mm incisions in the side and back of the shoulder and any remaining torn rotator cuff tissue is removed. Two 3mm holes are then drilled in the socket, and two more in the bump on the side of the humerus where the rotator cuff tendon would normally be attached.

The surgeon then fixes bone screws firmly into bone – these act as anchors, each with two sutures attached. The graft is cut to size and stitched into place between the anchors and the adjacent healthy rotator cuff tissue. The incisions are closed with adhesive sterile paper strips and the patient generally goes home the next day.

Jacqueline Huber, 65, an artist from Kew in Surrey, had three falls early last year which dislocated her right shoulder and left her in constant pain. Eventually, she had to keep the arm in a sling.

In September 2015 she saw Mr Tennent at Spire St Anthony’s, and he repaired a torn rotator cuff using the new procedure.

She says: ‘I’m a painter and photographer, and travel the world taking photos. But my shoulder and the pain were definitely holding me back.

‘Now I’m stable, I’m pain-free, and I’m able to get on with my life. I have just returned from a trip to Ecuador, the Amazon rainforest and the Galapagos Islands.’

The procedure is available privately, costing from about £7,000, and on the NHS at St George’s.

Professor Tony Kochhar, consultant orthopaedic surgeon at London Bridge Hospital and the University of Greenwich, said: ‘For patients who have a torn rotator cuff which is irreparable, the artificial ligament holds the shoulder joint in its correct position so can prevent arthritis developing, and allows physiotherapists to optimise the remaining muscles’ function, and so is a very good option.’