Python-inspired device could revolutionize rotator cuff surgery

Schematic of the python tooth-inspired device interposed between tendon a bone significantly enhances standard rotator cuff repair. Credit: Iden Kurtaliaj/Columbia Engineering.

When you think of pythons, you might imagine a huge snake wrapping around its prey.

But did you know that pythons also hold onto their prey with their sharp, backward-curving teeth?

These teeth are perfect for gripping soft tissue without cutting through it.

Dr. Stavros Thomopoulos, a professor of orthopedics and biomedical engineering at Columbia University, has been fascinated by this idea.

His team has now developed a new surgical device inspired by python teeth. This device could nearly double the strength of rotator cuff repairs, reducing the risk of re-tearing.

Dr. Thomopoulos specializes in studying how tendons attach to bones, which is crucial for rotator cuff repairs and other surgeries like ACL reconstructions.

His team’s recent study, published in Science Advances, reveals a python-tooth-inspired device that strengthens rotator cuff repairs.

“As we get older, more than half of us will suffer a rotator cuff tear, leading to shoulder pain and less mobility,” said Thomopoulos.

“The best solution is rotator cuff surgery, but many repairs fail within a few months. Our device, based on the design of python teeth, helps reattach tendons to bone more securely and can be customized for each patient.”

Rotator cuff injuries are very common, affecting over 17 million people in the U.S. each year. These injuries become more frequent with age, with over 40% of people older than 65 experiencing a tear.

Rotator cuff tears usually happen where the tendon attaches to the bone. Surgery is the main treatment, with over 600,000 procedures done each year in the U.S., costing about $3 billion.

However, these surgeries often fail, especially in older patients and those with severe tears. Failure rates range from 20% in younger patients to 94% in elderly patients with large tears.

The main problem is that sutures can tear through the tendon at the points where they grasp it, a phenomenon known as “suture pull-through” or “cheesewiring.”

To solve this problem, Dr. Thomopoulos’ team developed a device that mimics the shape of python teeth, which can grip soft tissues without tearing them. The team used simulations, 3D printing, and experiments on cadavers to perfect their design.

Lead researcher Iden Kurtaliaj created various tooth designs, optimizing them for grasping without cutting. The final product is a biomimetic device made of a biocompatible resin. It features an array of small teeth on a curved base that can grasp the tendon securely.

The teeth are only 3mm high, about half the length of a standard staple, so they won’t poke through the tendon. The base can be 3D-printed to match the specific shape of a patient’s shoulder bone.

“We designed it so surgeons can add it to their current procedures without changing their approach,” said Kurtaliaj.

The research was a collaborative effort, with input from Dr. Guy Genin at Washington University in St. Louis and Dr. William Levine, Chair of Orthopedic Surgery at Columbia University. They are now working on a bioabsorbable version of the device that will dissolve as the tendon heals, further improving its effectiveness.

The team is also preparing for a meeting with the FDA to bring their device to the market. This python-inspired device represents a significant step forward in rotator cuff surgery, offering new hope for millions of patients.