Rotator cuff tears affect 40% or more of people over the age of 60 and cause debilitating pain, reduced function and weakness in the shoulder. In excess of 250,000 rotator cuff repairs are performed annually in the United States. Despite improvements in our understanding of this disease process and advances in surgical treatment, healing following rotator cuff repair remains a significant clinical challenge and repair failure rates of 20-70% continue to be reported.
Further, abdominal wall hernias complicate nearly one-third of all abdominal surgeries, and an estimated 350,000 hernia repairs costing a total of US $3.2 billion are performed each year in the United States alone. However, repair outcomes are poor, with 24-43% of hernia repairs resulting in repair failure and hernia recurrence. It is estimated that just 1% reduction in recurrence rate will result in a cost saving of US $32 million.
Both of these clinical problems require a strategy for improving musculoskeletal soft tissue repair. Various synthetic and biologic materials have been used as repair augmentation scaffolds for these conditions, but have demonstrated limited success to date. To address this need, the Derwin Laboratory has been developing novel, composite scaffolds derived from biologic and synthetic materials. These scaffolds have shown promise for improving rotator cuff repair in laboratory research, and are now ready to be tested in human trials. Laboratory research on these scaffolds for abdominal wall repair is ongoing. In the future we expect to adapt these composite scaffolds for application in skin, craniomaxillofacial and genitourinary soft tissue regeneration.
Our research program aims to (1) develop biomaterial patches to improve healing and outcomes of soft tissue repairs such as, for example, repair of the tendons in the shoulder or hernias in the abdominal wall; (2) understand why rotator cuff muscles get fatty and smaller after rotator cuff injury and develop ways to limit or reverse this process; and (3) develop non-invasive methods to monitor the integrity and quality of healing soft tissue repairs.
Department of Biomedical Engineering, Cleveland Clinic
Orthopaedic and Rheumatologic Institiute, Cleveland Clinic
Department of Orthopaedic Surgery, Cleveland Clinic
Department of Orthopaedic Surgery, Bone and Joint Center, Henry
Ford Hospital, Detroit, MI
Department of Anatomic Pathology, Cleveland Clinic
Department of Quantitative Health Sciences, Cleveland Clinic
McCarron JA, Derwin KA, Bey MJ, Polster JM, Schils JP, Ricchetti ET, Iannotti JP: "Failure with Continuity"-- A Common Mechanism Of Rotator Cuff Repair "Healing". Am J Sports Med. 2012 Sep 27; [Epub ahead of print].
Leigh DR, Mesiha M, Baker AR, Walker E, Derwin KA: Host response to xenograft ECM implantation is not different between the shoulder and body wall sites in the rat model. J Orthop Res. 2012 May 22. doi: 10.1002/jor.22149 (epub 05/2012).
McCarron JA, Milks RA, Mesiha M, Aurora A, Walker E, Iannotti JP, Derwin KA: Reinforced fascia patch limits cyclic gapping of rotator cuff repairs in a human cadaveric model. J Shoulder Elbow Surg, 2012. doi:10.1016/j.jse.2011.11.039 (epub. 03/2012).
Sahoo S, Greeson C, Milks RA, Aurora A, Walker E, McCarron JA, Iannotti JP, Derwin KA: Effect of pretension and suture needle type on mechanical properties of acellular human dermis patches for rotator cuff repair. J Shoulder Elbow Surg. 2012 Oct;21(10):1413-21.
Lerner Research Institute
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9500 Euclid Avenue
Cleveland, Ohio 44195