Solving the enthesis problem: A startup called, Tetrous, introduces Enfix

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In the sports medical space in orthopedics, where innovation meets the demand for better solutions, there exists a lingering challenge: the enthesis. This often-overlooked junction between tendon and bone has proven to be a formidable obstacle in the field, contributing to the high failure rates and staggering costs associated with procedures like rotator cuff repairs. With failure rates ranging from 20 to 94% and annual costs surpassing $430 million, it’s clear that a solution is urgently needed.

Enter Tetrous, a pioneering startup aiming to tackle this orthopedic frontier head-on. Their groundbreaking approach revolves around reimagining tendon-bone attachment by focusing on the intricate biology of the enthesis. Unlike traditional methods that result in mechanically inferior scar tissue, Tetrous has developed a game-changing solution that promotes the regeneration of this vital structure.

At the heart of Tetrous’ innovation lies the EnFix implant, a demineralized bone fiber implant designed to recreate the enthesis. By leveraging the osteoinductive and osteoconductive properties of demineralized bone fibers, the EnFix implant grafts bone effectively, initiating endochondral ossification. This natural remodeling process not only stimulates bone growth but also facilitates the attachment of tendon to bone, restoring the enthesis in the process.

Preclinical studies have yielded promising results, showcasing the remarkable ability of the EnFix implant to recapitulate the structure of the enthesis. Histological analyses reveal the formation of collagen fibrils spanning from bone to tendon, while biomechanical studies demonstrate a stronger repair compared to conventional methods.

The simplicity of the EnFix implant’s surgical technique further underscores its potential for widespread adoption. Placed easily into the shoulder using a straightforward procedure, the implant allows for the incorporation of bone marrow elements, enhancing the healing process at the interface between bone and tendon.

Since its controlled launch in June 2023, Tetrous has made significant strides, with over 300 surgeries performed by a select group of surgeons in Australia and the USA. Initial clinical results have been overwhelmingly positive, with patients exhibiting healthier, thicker tendons as evidenced by postoperative MRIs.

For those accustomed to traditional approaches or considering alternatives like patches, Tetrous’ emphasis on addressing the underlying issue of the enthesis offers a paradigm shift in orthopedic care. With EnFix leading the charge, Tetrous is poised to redefine the standards of tendon-bone repair, by flipping the script to affect bone-tendon repair instead, paving the way for a future where orthopedic challenges are met with innovation and ingenuity.

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