Bengaluru: What began as an intraoperative challenge during a shoulder surgery has culminated in a patented technique that could offer an alternative to conventional suture anchors for rotator cuff repair, particularly in patients with weak or osteoporotic bones.Dr Banarji BH, additional director – Orthopaedics at Sakra World Hospital, has received a patent from govt of India for an invention titled “Apparatus for Trans-Osseous Rotator Cuff Repair”. The technique involves creating tunnels through the bone and using sutures to reattach the torn tendon, eliminating the need for a separate suture-anchor implant.Dr Banarji said the idea occurred during surgery on a woman with poor bone quality and a shoulder injury, when a conventional bone anchor repeatedly failed to hold.“The patient had poor bone quality, and the bone anchor was not holding properly and kept popping out. During the surgery, we tried a few modifications, and the modified approach worked well. That was when the idea struck me that we could go beyond the conventional technique,” he said.The technique was subsequently refined over six to seven years through repeated trials, redesigns and testing. Work included experiments with bone models and cadaver workshops. A team of seven to eight people, including colleagues, junior doctors, technicians and biomedical engineers, was involved in developing the apparatus.“We refined the technique and began practising it. Later, we designed an instrument to make the procedure more reproducible and allow surgeons to perform it more consistently. This eventually led to the patented device,” he added.“Traditionally, in rotator cuff repair, we reattach the torn tendon to the bone using a suture anchor, which is a small implant loaded with sutures. These anchors can be metallic, biodegradable or suture-based, but they come with certain disadvantages, including cost, the possibility of the anchor pulling out and other implant-related complications,” Dr Banarji explained.“To overcome these limitations, we developed a transosseous repair technique, in which we create tunnels through the bone and reattach the tendon without using an implant. We have also developed a specialised jig to make the technique more reproducible, and have received a patent for the invention,” he added. The patient’s own bone therefore serves as the fixation point.Dr Banarji said the technique has so far been used in more than 50 patients. He claimed it could reduce surgery costs by around 25-30% in appropriate cases.The technique may also have a potential biological advantage, he said, as the bone tunnels expose the repair site to bone marrow contents, including growth factors and stem-cell-containing elements that could aid tendon-to-bone healing.
