Just to remind everyone, you have the J&J (DePuy Synthes Products) ATI rotator cuff repair update coming soon. It was due 3Q19 and people have been told it would be out shortly when asking the company at September end (no I do not know exactly when but I imagine in the next week or two).
Should you have any doubt as the efficacy of ATI in tendon regeneration, OCC had a study (that was published in American Journal of Sports Medicine in 2015) on tennis elbow (lateral epicondylitis) that affects as many as 1-3% of the human population. At 1 year, on people who had failed traditional treatments (surgery, physio, corticosteroids, etc) had an 84% grip strength improvement. At 4.5 years an average of 207%. They reported an 88% return to work rate amongst patients related to a workers comp subset of 24 patients - 47% of which had been off work for average of 142 days!! Gives you an idea of how debilitating the injury is - and it is an injury, a chronic partial tendon tear.
In a 2018 questionnaire based review of patients who had received Ortho-ATI on varying tendon injuries (at an average of 23 months post), 83% of patients were ‘satisfied’ to ‘extremely satisfied' on pain improvement (and similar results for function). The tendons treated including gluteal, elbow, shoulder, achilles, knee and hamstring. To be honest I am surprised the rates are not closer to 100%. I know from experience that many of these patients will have been treated in isolation, without accompanying rehabilitation advice/support (literally you get a biopsy and a later injection from a Radiologist in most cases, that is it). I suspect the DePuy shoulder trial will have similar or better results hopefully with coordinated rehabilitation advice/support - certainly I have banged home the benefits of patient education with OCC management. Regeneration with ATI tenocyte cells is an ongoing natural physical process that massively augments, jumps a step and speeds up the bodies normal biological processes of tendon recovery and importantly enables adaptation (see tendinopathy cycle below). Patients who go and run on an ATI repaired and pain free patellar repair at 4 weeks for example are going to see far worse long-term results than those who engage in slow isometric and eccentric rehabilitation programs from 4-12 weeks for example. I progressed my bicep over half a year from 4KG isometrics to 10KG eccentrics over 6 months. Didn't go near a pull-ups for a year (I am now look like a typical over muscled meat-head at the gym / boxer on the punch bag). Rotator cuff injuries normally see similarly cautious protocols and if DePuy has advised patients to do similar they will see improved success rates with ATI.
Shoulder injuries are the worse injuries in terms of repair success - the least stable and most complex joint. Anything over an 70% success rate would frankly be amazing.
Tendinopathy cycle:
What happens with tendinopathy in simple terms, is your cells never break the tear and repair cycle. Literally imagine picking a scab early every time. That's what happens with chronic degenerative injuries. Even picking the weaker scar tissue. Sufferers fall into a pattern of re-tearing unhealed injuries characterised by weaker type 3 collagen before it can turn into stronger and supple type 1 collagen. This is where OCC takes your good tendon stem cells (about 10,000 tenocyte cells) and grows them in a petri dish reinjecting millions of cells that encourage a proliferation of type 1 collagen and you break the tendinopathy cycle. The cycle above is very simplified and relates to typical rehabilitation protocols from physiotherapy. Some patients are simply too far down the tendon disrepair scale (literally physical tears) to ever escape the cycle - that's where ATI steps in and gives them a huge lift up the scale so to speak. They can fall down again if they overload (like running too early on a repaired and painless patellar per my example above). Those are likely to represent that small percentage that were not satisfied from the procedure.
Given ATI is literally a massive boost to the body's own natural healing functions it is a shame, as with better rehabilitation I believe OCC could have near 100% success rates.
(20min delay)