A patch made from cow tissue that helps repair painful shoulder injuries is now available on the NHS.
Pam Lock, 43, a university lecturer from Bristol, was among the first UK patients to benefit, as she tells Richard Webber.
The patient
Rowing competitively and working as a tree surgeon in my 20s almost certainly caused tissue damage in my right shoulder, which led to pain that worsened over the years.
It got so bad that it triggered migraines, too, and, before long, I struggled with tasks that involved raising my arms above my head; I couldn’t even use a hairdryer. My gardening was increasingly limited to lighter tasks. Consequently, in my 30s, I stopped rowing and changed to an office job.
I tried painkillers and a steroid injection to reduce inflammation and saw physiotherapists, osteopaths and chiropractors — but to no avail. Eventually my GP referred me to consultant orthopaedic surgeon Andrew Chambler, in 2018.
A patch made from cow tissue that helps repair painful shoulder injuries is now available on the NHS. A stock image is used above
An MRI scan revealed damage to a tendon (which connects muscle to bone) in my right shoulder; it was being squeezed, leading to pain and difficulty moving. In February 2018 I had decompression surgery, where they slightly shaved the tissue between the shoulder ball-and-socket joint and the bone above, to create more space in the joint and stop the tendon being crushed.
This brought pain relief for almost a year, but eventually the pain returned.
After hoping the problem had been cured, it was devastating. I felt very low and turned to hypnotherapy to help me deal with the prospect of living with long-term pain. Then in June 2019, I had another scan of the shoulder, which revealed I now had a partial tear in a tendon.
Mr Chambler explained that my torn tendon was in the rotator cuff, a group of muscles and tendons in the shoulder that help the joint move. The tear was constantly rubbing inside the joint, causing inflammation, and hurt with movement.
I could have had another decompression or an op to sew the torn tissue back on, but I was reluctant to endure the painful recovery when there were no guarantees it would work.
Mr Chambler then said he was offering a new treatment, where a small patch is placed over the tear in a minimally invasive procedure with a quicker recovery.
The patch was made from cow tissue and contained collagen, which helps stimulate the body to repair the tear and my own body tissue would grow into it to strengthen it.
I had the one-hour operation in December 2020 under a general anaesthetic. I arrived at lunchtime and was home for a late dinner — it was that quick.
My arm was in a sling for two weeks and I was prescribed some strong pain relief for seven days; after that I just took ibuprofen or paracetamol when it hurt.
As it healed, I did stretching exercises and lifted light weights to build strength.
Now my shoulder is much stronger; I can lift more weight in the garden, stir for longer in the kitchen and I’m back swimming several times a week.
Not long ago, I was worried that I’d have to live with the pain and weakness for the rest of my life. Now, as my shoulder continues to improve, I feel positive about the future again.
The surgeon
Andrew Chambler is a consultant orthopaedic surgeon at Sulis Hospital Bath and BMI Bath Clinic.
The rotator cuff is a group of four muscles and tendons that allows us to move our shoulder joint. These tendons commonly suffer from wear and tear with age or damage from injury. Around 2 per cent of 40-year-olds are affected and the figure increases with age. Almost 10,000 repair ops are done each year.
Most rotator cuff tears don’t cause symptoms but if they reach a certain size or if it affects an important part of the tendons, significant pain and loss of function can occur. That’s because the muscle pulls on a torn tendon, causing pain and subsequent weakness.
The torn end can also catch on surrounding structures. As a result, the joint can become unbalanced, forcing other muscles around the shoulder to work harder (which worsens inflammation and pain).
Normal day-to-day activities, such as dressing and cooking can all be affected as patients can no longer lift their arm properly without pain. Strain can be placed on the shoulder blade, which can even trigger headaches in some people.
A full thickness tear is when the tendon is torn completely away from the bone. A partial thickness is where some of the tendon tears away, leaving some attachment which is then under greater strain from the muscle force. If left untreated, partial tears can progress to full thickness tears.
Treatment begins with physiotherapy, painkillers or steroid injections to reduce inflammation but these can weaken the tendon and don’t always work.
We can offer surgery to repair the tear, sewing it to the bone with stitches. This has a long recovery time and larger repairs are likely to tear again.
Sometimes if the tear is too big it cannot be repaired, and patients must live with the pain or consider other major surgery such as a shoulder replacement.
The new Regeneten patch offers a minimally invasive option, where we retain normal tissue and encourage the body to repair the tear itself. It can be offered to tears of all sizes (although its effectiveness on complete tears needs further research) and has a quicker recovery than other surgical options. It has been used extensively in Australia and the U.S. but only came on to the UK market last year.
The patch is stamp-sized and made from the protein collagen derived from a cow. We have a similar protein supporting our joints and tissues. It is treated to remove other cells so our bodies won’t reject it and the patch seems to encourage the tendon’s natural healing response, to facilitate new tissue growth to repair it.
During an hour-long keyhole procedure — under general or regional anaesthetic — I make a 1cm incision at the back of the shoulder to insert a tiny camera, and two or three similar incisions at the side of the shoulder to allow instruments into the shoulder.
The damaged tendon is cleared of inflamed tissue and bony spurs that might catch the tendon, using tiny shavers and burrs. The patch is inserted ‘rolled up’, then placed atop the damaged tendon, and secured with absorbable staples — these remain in place until new tissue grows, then dissolve.
We close the incisions and the patient’s arm is placed in a sling for up to a fortnight.
Physiotherapy is required to strengthen the joint and surrounding muscles, but most patients return to work after three to six weeks. It can take up to nine months to regain full strength.
The management of partial thickness tendon tears remains controversial, with patients often having to suffer a full thickness tear before surgery is offered. This new treatment gives us the option to retain the remaining healthy tendon and encourage repair before it reaches that point.
Patients also have less time in the sling (two weeks compared to four to six if the tendon is sewn into the bone) and return to everyday activities sooner than other treatments.
A recent study showed that, compared with traditional surgical repair, patients reported a significant improvement in shoulder function after two and six weeks with the Regeneten. They also reported significant improvements in pain, function and quality of life after a year.
Pam was one of the first in the UK to have the treatment — around 40 have had it so far. Reassuringly, all patients are doing well.
The Regeneten implant costs the NHS £6,000 and £10,000 privately.