For Patients

Arthroscopic Transosseous (ATO) Rotator Cuff Repair

Transosseous literally means “through the bone” – meaning tunneling suture through the bone to fix your torn rotator cuff, the most stable repair available.

ATO should be your first choice to discuss with your surgeons for rotator cuff repair:

• Less postoperative pain than anchors
• Uses your own stem cells for healing
• Significantly cheaper than using anchors for repair
• No foreign body implant left behind

Rotator Cuff Tears

  • Rotator cuff tear is a painful condition with almost 2 million Americans per year visiting their doctors because of rotator cuff pain
  • Over 500,000 Americans have rotator cuff repair surgery annually
  • Over 1.4 million shoulder arthroscopies are done worldwide each year
  • Most cuff tears occur in people over the age of 40 with significant increase due to aging population

Anatomy

  • Your shoulder has 3 bones: upper arm (humerus), shoulder blade (scapula), and collarbone (clavicle)
  • Your shoulder is a ball-and-socket joint with the ball of your upper arm bone fitting into a shallow socket in your shoulder blade
  • Your arm is kept in the shoulder socket by the rotator cuff, 4 muscles that come together as tendons covering the head of the humerus
  • The rotator cuff helps to lift and rotate your arm

Symptoms

  • Symptoms of a torn rotator cuff include:

Pain at rest and at night

Pain and weakness when lifting and lowering your arm or with specific movements

Crackling sensation when moving your shoulder in certain positions

  • Sudden tears, i.e., a fall, cause intense pain and may have a snapping sensation and immediate weakness in your upper arm
  • Slower tears due to overuse cause pain and arm weakness upon lifting, or pain that moves down your arm
  • Mild pain present when lifting your arm over your head may benefit from aspirin or ibuprofen
  • Over time, pain may become more noticeable and no longer goes away with medications
  • Pain and weakness in your shoulder may make routine activities more difficult

Medical History and Physical Exam

  • After discussing your symptoms and medical history, examination will determine whether your shoulder is tender or whether there is a deformity
  • Range of motion will be measured by moving your arm in several different directions
  • Your doctor will also test your arm strength and order X-rays or MRI (imaging tests) to confirm your diagnosis

Treatment

  • The goal of any type of treatment is to reduce pain and restore function
  • Your doctor will consider your age, activity level, general health, and the type of tear when making treatment option recommendations
  • Typically doctors first recommend management of rotator cuff tears with physical therapy and other nonsurgical treatments

Nonsurgical Treatment

  • Rest and limiting overhead activities
  • Use of a sling to help protect your shoulder and keep it still
  • Limiting or avoiding activities that cause shoulder pain
  • Nonsteroidal anti-inflammatories (i.e., ibuprofen) to reduce pain and swelling
  • Strengthening exercises and physical therapy to restore movement and improve flexibility and range of motion
  • If rest, medications, and physical therapy do not relieve your pain, anesthetic and cortisone (steroid) injection may be tried  

Surgical Treatment May Be a Good Option If…

  • Your symptoms have lasted 6-12 months
  • You have a large tear (more than 3cm) and surrounding tissue quality is good
  • You have significant weakness and/or loss of function in your shoulder
  • Your tear was caused by an acute injury
  • Surgery to repair a torn rotator cuff most often involves re-attaching the tendon to the head of humerus (upper arm bone)
  • Outpatient surgery is the most common surgery 
  • Your orthopaedic surgeon will discuss with you the best procedure to meet your individual health needs

Rotator Cuff Repair Surgery

  • Rotator cuff repair is typically performed arthroscopically through small incisions on an outpatient basis
  • A small diameter device is inserted into incisions to view the affected area on a monitor and surgical instruments are inserted to make repairs
  • Rotator cuff tears can be massive tears (>5cm), large tears (3-5cm), and small to medium tears (1-3cm)
  • Rotator cuff repair typically uses all-suture or anchors made of plastics or metal
  • Patients and surgeons may be uncomfortable with implanted devices, like anchors, for repairs because they leave behind foreign body implants, are invasive, and have increased risk of complications
  • Surgery with anchor implants are expensive and may have increased pain and more complicated revisions
  • The average cost of rotator cuff repair surgery ranges from $7,000 to $11,000
  • Anchors are the largest cost of cuff repair surgery ranging from $600-6,000 per procedure, while rotator cuff repair with all suture is substantially less expensive
  • In this value-based era of medicine, Tensor transosseous tunneling with all-suture provides advantages over anchors

The Tensor Solution

  • Tensor is a reusable tunneling device with an all-suture, implant-free, clinically effective solution that’s easy for your surgeon to use
  • The Tensor Shoulder Repair System has advantages of: 
    • Less postoperative pain
    • No foreign body implant
    • Uses your own stem cells
    • Lower cost
  • The Tensor Shoulder Repair System:
    • Studies have shown that Tensor is effective rotator cuff treatment, with less postoperative pain allowing patients to get back to an active lifestyle
    • Studies demonstrate the Tensor tunneling system with all-suture improves patient outcomes, at a significantly lower cost than anchors
    • Tensor reduces the need for additional procedures, revisions, opioids, and repeat physician visits

Post-Surgery

  • Following surgery, keep incisions clean and dry to avoid infection
  • You may shower by placing a plastic covering over the surgical site beginning the day after surgery 
  • You may shower with no covering on the 3rd postoperative day
  • Rest is key to recuperation
  • Use an ice pack to help reduce inflammation during the first 3-5 days after surgery 
  • Avoid driving a car for 6 to 12 weeks, or until your doctor says you no longer need to wear a sling  
  • At 3 to 6 weeks after surgery, you will begin physical therapy to move your shoulder around out of the sling  
  • By 12 to 14 weeks after surgery, most patients regain the majority of their passive motion and begin gentle strengthening that progresses over 3 months
  • Always refer to specific instructions from your doctor should you have any questions or concerns following surgery
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