ValleyOrtho’s Dr. Tito Liotta and Tetrous EnFix technology featured in Aspen Daily News

A doctor at Valley View Hospital in Glenwood Springs has become the second physician in the country to begin using a special new technology for rotator cuff repairs, a common operation for manual workers and athletes.

Dr. Ferdinand “Tito” Liotta, who specializes in shoulder reconstruction, said the “EnFix” demineralized bone implant has dramatically improved the success rate for his rotator cuff operations.

“In this valley, we have 80-year-olds who are skiing 150 days a year and 80-year-olds who are demanding to ride their bike 2,000 miles a summer,” Liotta said. “This is another way of taking a tendon that’s not so good in that older age group and improving it.”

While structure failures typically occur in at least 20% of rotator cuff repairs, Liotta said failure has only occurred in about 7% of operations where he’s used the new tech. Liotta had used the EnFix on 29 patients as of June 20.

“This was a change for me that made me better, made me faster and easier, as opposed to just something new or slick,” Liotta said.

According to Tetrous, the company that makes the new technology, more than 2 million people in the United States experience some type of rotator cuff problem each year, leading doctors to perform 500,000 rotator cuff repairs annually. Between 20 to 70 percent of those repairs fail structurally, depending on how you classify failure.

Liotta first learned of the technology, developed by California-based company Tetrous Inc., while attending a yearly sports medicine conference in July, 2023. The only other doctor using the technology in the United States so far is a doctor in Chicago who works with professional athletes.

Liotta said that shoulder use is especially important for the Roaring Fork Valley’s large community of construction workers and other trade workers.

“That guy framing and doing construction, in my mind, is a professional athlete,” Liotta said. “His livelihood is how his body works for him. If I can’t keep that out there, then he’s dysfunctional.”

The rotator cuff is a group of four muscles that stabilize the shoulder by holding the arm bone into the shoulder socket. Over time, most people experience some separation between these muscles and the bones of the shoulder, which decreases the shoulder’s usefulness. The gradual deterioration is typically painless, but it doesn’t heal.

“Just like any rope, it wears out. You pull the bucket out of the well enough times, the rope will tear, and the rotator cuff does the same,” Liotta said.

In some cases, however, the tear happens quickly from overwork, causing pain and drastically reducing a person’s ability to use their shoulder. In this case, doctors may choose to operate.

Despite the many technologies developed to help re-attach the muscles to the bones, Liotta said it is a stubborn problem and difficult to fix. Liotta said doctors can reconnect the muscles to the bone, but the reattachment typically forms as scar tissue, which can re-tear easily. Liotta said the success rates for previous methods are “dismal.”

The EnFix helps re-establish that natural connection without creating scar tissue, Liotta said. The device is a small plug of cadaver bone, which Liotta soaks in blood platelets (cells that notify the body to begin healing) and inserts into the patient’s native shoulder bone. The plug serves as an anchor where the muscle can form a stronger reattachment.

Liotta said the EnFix is also faster to install than previous technologies, adding only an extra minute to the overall operation.

“It’s a quicker surgery, patients are under anesthesia less and infection risk is less but yet we have this super cutting edge biologic technology that’s being done,” Liotta said.

As for the cost, Liotta said the plugs cost around $300 on top of other operation expenses.

Liotta said most surgeries are available in Glenwood, but patients can also receive operations at ValleyOrtho’s surgery center near Willits.