How Coke bottle plastic can f ix your snapped shoulder
FABRIC made from the same material as plastic Coca-Cola bottles is being used to fix disconnected shoulder joints. The injury occurs when the ligament holding together the collarbone and the shoulder blade snaps and the two become permanently detached, causing severe and often chronic shoulder pain.
The injury is regularly seen in rugby players – with several current and former Six Nations stars having had the ‘Coke-bottle fix’ – including Welsh flanker Sam Warburton, who holds the record for the most Wales caps as captain.
Others are Welsh team-mates Alun Wyn Jones and Leigh Halfpenny
One in ten of all shoulder injuries are acromioclavicular joint – or ACJ – tears, and they can be caused by any big impact fall, such as coming off a bicycle or a rugby tackle.
While ACJ dislocation used to be most common in professional sports people, surgeons are now seeing many more of these injuries as more of us take up outdoor sports.
Traditional surgical treatments included repairing the ligaments, or moving ligaments from another part of the body to replace them.
The procedure now preferred by surgeons involves using a braided suture made from polyethylene terephthalate (PET), the same recyclable material used to make plastic bottles.
Richard Evans, consultant orthopaedic surgeon at Spire Cardiff Hospital, was an early convert to the procedure, called Lockdown, and has used it to repair ACJs in several rugby players.
Warburton, 28, tore his ACJ in 2008. He had a Lockdown operation, carried out by Mr Evans, and was back in training three months later, and playing first-team rugby after just 18 weeks.
Mr Evans says: ‘This is a very robust repair, effectively “lassoing” the shoulder blade back on to the collarbone. And since this is a synthetic ligament, you have that strength immediately.’ The surgeon adds: ‘Any fall could cause slight injury to the acromioclavicular joint. However, a high-impact force such as falling off a bicycle will cause a full tear.
‘I have seen a large increase in these injuries in cyclists. These patients end up with a gross deformity of the shoulder, and significant pain and weakness.
‘Unfortunately many are mismanaged and told that physiotherapy alone will work.’
The Lockdown procedure takes an hour and is carried out under general anaesthetic. The surgeon first makes a 5cm to 6cm incision over the top of the collarbone, after which a device is used to measure the distance between the coracoid bone, a natural projection on the shoulder blade, and the collarbone.
The polyester suture is then looped around the coracoid bone while the other end is tied around the collarbone. It is secured in place with a screw. After the operation, which is available on the NHS, the patient wears a sling for two weeks and should have some rehabilitation before being able to fully use the arm again without pain.
Colin Marchant, 65, a company director from Taunton in Somerset, was riding his mountain bike downhill when he had an agonising fall last February. He recalls: ‘I was going too fast and must have hit a hole, because I flew over the handlebars and landed on my right shoulder. It was agony.’ He visited A&E the next morning, and the doctors referred him to a physiotherapist. He had months of treatment, but was still in agony. Colin says: ‘My right arm was 2in longer than my left, and I had a huge bump on my shoulder – I couldn’t even lift a kettle.’ After further advice from a surgeon, who said that it would heal naturally – and another three months of pain instead – he saw Mr Evans at Spire Cardiff Hospital. ‘He told me it was a separated shoulder, which is a very serious injury, but he could repair it,’ says Colin. He had the surgery in August, followed by months of recovery. ‘It took time to heal, but has changed my life,’ says Colin. ‘Now I’m out of pain at last, and was even able to go for a New Year’s Day swim at Woolacombe in Devon, which would have been impossible last year. It’s changed my life.’ Tony Kochhar, consultant orthopaedic surgeon at London Bridge Hospital, says: ‘AC dislocation is very common, especially among cyclists and skiers, and is a very difficult problem to treat. ‘Surgery carries a 20 per risk and complication rate, but some patients don’t do well with physiotherapy. This is a well recognised technique that works very well.’