Dr. Tito Liotta, orthopedic surgeon at ValleyOrtho, has implemented a new standard of care for patients with rotator cuff tears, using a new demineralized bone implant technology called EnFix for bone-to-tendon repair by placing an implant that extends into the bone-to- tendon interface. This new technology can significantly improve outcomes for Enthesis Failure Syndrome, or rotator cuff re-tear. Dr. Liotta is only the second doctor in the United States to use this new technology and the first doctor in Colorado.

“In my opinion using demineralized bone at the repair site will become the standard of care, as there is no denying the biological benefit,” says Dr. Liotta. “The process of demineralizing bone makes the inherent growth-factors available for the body to use in the healing process”.

Dr. Liotta began using the EnFix implant in rotator cuff repairs in summer 2023. Today, he uses them in almost all of his rotator cuff surgeries. He has observed reduced scar tissue at the site, quicker healing times and a decrease in the rate of re-tear.

In the United States, more than 2 million people experience some type of rotator cuff problem each year and nearly 500,000 rotator cuff repairs are performed annually. Between 20 to 70 percent of those repairs fail structurally. In traditional repair, the bone-to-tendon interface (known as the enthesis) does not re-form in its normal structure following surgery, but instead results in the formation of scar tissue. Scar tissue does not allow proper transmission of tensile load from soft tissue to bone and is prone to fail. These failure rates increase with tear size. This is one of the primary reasons many people delay or try to avoid surgery. Living with rotator cuff injuries can significantly impact people’s ability to get back to their daily activities such as sports and work.

Previously, Dr. Liotta was implanting an “overlay” of demineralized bone, essentially a band aid of spongy bone, sandwiched between the humerus (upper arm bone) and the tendon of the rotator cuff. This technique was time consuming and technically challenging. The EnFix implants allow Dr. Liotta to precisely and quickly deliver demineralized bone fibers to the repair site, where failure often occurs. The unique design results in an implant that is placed directly into the bone, triggering the body’s natural healing process much like when bone is formed in embryonic development.

“The results are promising,” he says. “For me, the EnFix implants are a great solution as they add very little time to the case and are technically much easier to apply than other iterations of demineralized bone I have tried.”

“Valley View is at the forefront of rotator cuff repair surgery,” adds Dr. Liotta. “We believe that the addition of this technology will help patients heal and decrease the risk of failure or re-tear.”

According to Tetrous, Inc, the company that developed the demineralized bone implants, there is opportunity to apply this technology to other bone-to-tendon healing repairs including enthesis repairs to the ankle, hip, knee and elbow.

Dr. Liotta is welcoming new patients at Valley Ortho locations in Eagle, Glenwood Springs and Willits. Learn more or schedule an appointment at 970.384.7140.