Niamh O’Neill and Kamran Zamanian, iData Research11.15.23
The global orthopedic soft tissue repair market includes Achilles tendon repair and reconstruction devices, rotator cuff repair and reconstruction devices, shoulder labrum repair devices, biceps tenodesis repair devices, anterior and posterior cruciate ligament (ACL/PCL) reconstruction products, meniscal repair devices and hip arthroscopy devices.
The global market for orthopedic soft tissue repair covers the following regions:
The market has varied in its recovery from the outbreak of COVID-19, which began at the end of 2019 and was declared a public health emergency by the World Health Organisation in January 2020. The North American market demonstrated the fastest recovery, while Western Europe was the worst hit region. The most affected countries in Europe include France, Germany, the United Kingdom and Russia.
North & Latin America
In North America, during the initial lockdown period of March 2020 through to April 2020, surgical procedures plummeted by nearly fifty percent. However, hospitals were quick to implement effective processes that facilitated the return to elective procedures and, after reopening, surgical procedures rebounded in May 2020 through to June 2020 to their 2019 levels.
Overall, by the end of 2020, the reported decline in procedures was, on average, 10% lower than the previous year. The decline in Latin America was far more pronounced. Chile, for example, reported a procedural drop of over 20% due to COVID-19 (Barahona, et al., 2021).
Western, Central & Eastern Europe
In Europe, various countries began implementing strict lockdown measures to curb the spread of infections. Although there was a decline in infections by June 2020, the second wave rapidly increased infections across Europe in October 2020. Curfews and stringent lockdown measures were put in place again and elective surgeries were stopped in certain European countries.
Countries like Germany (Life Science Market Research, 2022), Switzerland (Rachamin, Meyer, Rosemann, & Grischott, 2022), and Portugal (Ribau, Vale, Xará-Leite, & Rodrigues-Pinto, 2021) saw a drop in procedures from 10%-16%, on average. Contrasting this, procedures in the United Kingdom declined by about 20%. In Spain, surgical procedures dropped by one third of its normal volume at the height of the pandemic (Cano-Valderrama, et al., 2020).
Asia Pacific
The Asia Pacific region was one of the fastest to respond to the COVID-19 pandemic. India, one of the worst hit regions of Asia Pacific, reported a reduction of more than 40% in orthopedic surgeries performed (Vaishya, Vaish, & Kumar, 2021). In Australia, the number of people who were admitted to the hospital for orthopedic trauma decreased by 30% (Probert, et al., 2020). In Japan, elective surgeries were limited to 50% of their usual capacity in 2020 (Kurozumi, et al., 2021).
Middle East & Africa
In the Middle East, the United Arab Emirates imposed tight restrictions on its citizens. Movement restrictions and night curfews were imposed to facilitate disinfection strategies in the region. During the first year of the COVID-19 pandemic, Saudi Arabia reported an orthopedic procedural decline of 35% compared to the previous year’s volume (Sadat-Ali, et al., 2021). Africa was badly hit by the pandemic in 2020, with cases being reported in every country on the continent within three months of the first reported case. South Africa reported a surgical decline of more than 50% during April 2020, compared with the same period the previous year (Waters, et al., 2021).
The latter half of 2020 saw the second wave of national lockdowns as new variants of COVID-19 began to spread. However, by 2021, the rollout of vaccines and more targeted restrictions to reduce the spread allowed procedures to resume. Since then, there have been small surges in cases but no policies put in place causing the industry to close down. As a consequence of vaccination rates, the market has mostly rebounded and is working through the backlog of demand.
Aside from vaccination rollouts, one of the main factors that has enabled the market to rebound swiftly is that hospitals and surgery centers are already set up to manage and control medical crises. The decrease in procedure numbers was primarily caused by government restrictions on elective surgeries. Recommendations to stop surgical procedures was in the context of the global uncertainty surrounding COVID-19 and its long-term implications, risk of transmission, the insufficient testing capabilities, limited availability of personal protective equipment (PPE) for medical staff and disaster planning to resourcefully prioritize ICU beds and ventilators for the worst affected patients.
In fact, over the past few years, orthopedic soft tissue repair procedures have seen a surgical shift from traditional hospital settings to surgery centers. This proved to be beneficial during the pandemic as surgery center procedures could continue without compromising hospital bed capacity.
The pandemic revealed some concerning supply chain issues in the healthcare sector. Supply chain issues range from the availability and supply of products to staffing shortages in healthcare settings and delivery services (Gooch & Gonzalez, 2021). Nearly all hospitals and healthcare facilities reported supply chain challenges in 2021 (De Paoli, 2022).
Although they are more prepared to manage these challenges than they were at the beginning of the pandemic, it is expected that there will be continued delays and disruptions to the medical supply chain. To deal with this, hospitals and surgery centers have implemented strategies to mitigate negative consequences as much as possible, such as forecasting product and material requirements, adjusting timelines to accommodate delayed shipping and diversifying their suppliers. However, the effects of these supply chain issues are ongoing and remain a source of concern for healthcare executives and medical manufacturers and distributors.
For the orthopedic soft tissue repair market specifically, segments that contain grafting options may be less affected than those that rely more heavily on fixation devices. For example, in the North American market, grafts are sourced from tissue banks in the United States and are therefore not affected by the added complications and delays associated with importing supplies from overseas. For instance, the Achilles tendon, rotator cuff and ACL/PCL repair and reconstruction segments may be less affected than other segments that rely on internationally manufactured medical devices.
In contrast, surgical procedures of the shoulder labrum, biceps tenodesis, meniscal repair and hip arthroscopy segments rely heavily on fixation devices. While this is cause for some concern in some regions, developing surgical techniques and technological advancements may accelerate the trend towards grafting options where possible.
For example, depending on the severity of the tear and patient needs, hip arthroscopy can be performed using autografts and allografts. However, reliance on allografts may present its own challenges as the demand for donor tendons far exceeds the supply of available allografts.
As the COVID-19 pandemic remains an ongoing crisis, it is assumed that COVID-related volatility will persist and supply chain pressures could negatively impact the market.
Sports Industry
Tendon and ligament injuries most commonly occur among professional sports players. Sports medicine manufacturers continue to collaborate with professional sports associations to develop the most up-to-date and clinically approved treatment options. This results in financial support for related research and development activities, clinical trials and studies, as well as educational programs and fellowships.
Demographic Factors
With an ever-aging population trend, mixed with an increasing number of younger patients and active lifestyles, stable growth is expected to continue in the global orthopedic soft tissue repair market. With the increased prevalence of anti-arthritic drugs and pain medication, people are able to maintain active lifestyles at a much older age. This leads to a higher number of elderly patients requiring soft tissue repair and reconstruction treatment.
Technological Advancement
Over the last decade, market development has focused on new materials and surgical techniques. As a result, all-suture anchors and PEEK CF materials have been adopted for soft tissue repair and reconstruction procedures.
The adoption of these materials is also fueled by continuing development of the surgical technique. In addition, synthetic grafting materials reported encouraging outcomes in specific soft tissue repair, driving acceptance in the market. Further development in soft tissue repair techniques and products is expected to benefit from the recent advancement in biomaterials, cell-based technologies, 3D printing and the overall adoption of knee arthroscopy.
References:
1 Barahona, M., Infante, C. A., Palet, M. J., Barahona, M. A., Barrientos, C., & Martinez, A. (2021). Impact of the COVID-19 Outbreak on Orthopedic Surgery: A Nationwide Analysis of the First Pandemic Year. Cureus, 13(8). doi:10.7759/cureus.17252
2 Cano-Valderrama, O., X Morales, X., Ferrigni, C. J., Martín-Antona, E., Turrado, V., García, A., . . . Torres, A. J. (2020). Reduction in emergency surgery activity during COVID-19 pandemic in three Spanish hospitals. British Journal of Surgery, 107(8), e239. doi: https://doi.org/10.1002/bjs.11667
3 De Paoli, A. (2022, March 23). Views From labor to laundry, supply chain issues are impacting the healthcare industry. EBN. Retrieved from https://www.benefitnews.com/advisers/opinion/supply-chain-issues-are-impacting-the-healthcare-industry
4 Gooch, K., & Gonzalez, G. (2021, November 2). Supply chain issues are here to stay: Health leaders share predictions, strategies. Becker's Hospital Review. Retrieved from https://www.beckershospitalreview.com/hospital-management-administration/supply-chain-issues-are-here-to-stay-health-leaders-share-predictions-strategies.html
5 Kurozumi, T., Minehara, H., Kim, J.-W., Oh, C.-W., Miclau, E., & Balogh, Z. J. (2021). Orthopaedic trauma care during the early COVID-19 pandemic in the Asia-Pacific region. OTA International, 4(1). doi:10.1097/OI9.0000000000000119
6 Life Science Market Research. (2022, November 2022). Retrieved from Germany Surgical Procedure Volumes (SPV) Database: https://www.lifesciencemarketresearch.com/procedure-volumes/germany-surgical-procedure-volumes-database
7 Probert, A. C., Sivakumar, B. S., An, V., Nicholls, S. L., Shatrov, J. G., Symes, M. J., & Ellis, A. M. (2020). Impact of COVID-19-related social restrictions on orthopaedic trauma in a level 1 trauma centre in Sydney: the first wave. ANZ Journal of Surgery. doi:https://doi.org/10.1111/ans.16375
8 Rachamin, Y., Meyer, M. R., Rosemann, T., & Grischott, T. (2022). Impact of the COVID-19 Pandemic on Elective and Emergency Inpatient Procedure Volumes in Switzerland – A Retrospective Study Based on Insurance Claims Data. International Journal of Health Policy and Management. doi:10.34172/ijhpm.2022.6932
9 Ribau, A., Vale, J., Xará-Leite, F., & Rodrigues-Pinto, R. (2021). Impact of COVID-19 pandemic and national lockdown in an orthopaedic and traumatology department—a comparison with the homologous period of 2019. Porto Biomed Journal, 6(1). doi:10.1097/j.pbj.0000000000000109
10 Sadat-Ali, M., Al-Dakheel, D. A., Al-Omran, A. S., A, A.-M. S., Al-Sayed, H. N., Bubshait, D. A., & al, e. (2021). Pattern of Orthopedic Trauma during COVID-19 Crisis in Saudi Arabia: Report from Level I Trauma and COVID-19 Center. Journal Musculoskelet Surgery and Research, 5, 262-265. Retrieved from https://journalmsr.com/pattern-of-orthopedic-trauma-during-covid-19-crisis-in-saudi-arabia-report-from-level-i-trauma-and-covid-19-center/
11 Vaishya, R., Vaish, A., & Kumar, A. (2021). Impact of COVID-19 on the practice of orthopaedics and trauma-an epidemiological study of the full pandemic year of a tertiary care centre of New Delhi. Int Orthop, 45(6), 1391-1397. doi:10.1007/s00264-021-05021-5
12 Waters, R., Dey, R., Laubscher, M., Dunn, R., Maqungo, S., McCollum, G., . . . Held, M. (2021). Drastic reduction of orthopaedic services at an urban tertiary hospital in South Africa during COVID-19: Lessons for the future response to the pandemic. South Africa Medical Journal, 111(3), 240-244. doi:10.7196/SAMJ.2021.v111i3.15263
Niamh O’Neill is a research analyst at iData Research. She works on research projects regarding the medical device industry, publishing the U.S Orthopedic Soft Tissue report series.
Kamran Zamanian, Ph.D., is CEO and founding partner of iData Research. He has spent over 20 years working in the market research industry with a dedication to the study of medical devices used in the health of patients all over the globe.
The global market for orthopedic soft tissue repair covers the following regions:
- North & Latin America
- Western, Central & Eastern Europe
- Asia Pacific
- The Middle East and Africa
The market has varied in its recovery from the outbreak of COVID-19, which began at the end of 2019 and was declared a public health emergency by the World Health Organisation in January 2020. The North American market demonstrated the fastest recovery, while Western Europe was the worst hit region. The most affected countries in Europe include France, Germany, the United Kingdom and Russia.
The Impact of COVID-19 on Orthopedic Procedures
From March to July 2020, much of the world was under national lockdowns to reduce the spread of COVID-19. Part of these lockdowns involved the restriction of elective surgeries, with the exception of emergencies.North & Latin America
In North America, during the initial lockdown period of March 2020 through to April 2020, surgical procedures plummeted by nearly fifty percent. However, hospitals were quick to implement effective processes that facilitated the return to elective procedures and, after reopening, surgical procedures rebounded in May 2020 through to June 2020 to their 2019 levels.
Overall, by the end of 2020, the reported decline in procedures was, on average, 10% lower than the previous year. The decline in Latin America was far more pronounced. Chile, for example, reported a procedural drop of over 20% due to COVID-19 (Barahona, et al., 2021).
Western, Central & Eastern Europe
In Europe, various countries began implementing strict lockdown measures to curb the spread of infections. Although there was a decline in infections by June 2020, the second wave rapidly increased infections across Europe in October 2020. Curfews and stringent lockdown measures were put in place again and elective surgeries were stopped in certain European countries.
Countries like Germany (Life Science Market Research, 2022), Switzerland (Rachamin, Meyer, Rosemann, & Grischott, 2022), and Portugal (Ribau, Vale, Xará-Leite, & Rodrigues-Pinto, 2021) saw a drop in procedures from 10%-16%, on average. Contrasting this, procedures in the United Kingdom declined by about 20%. In Spain, surgical procedures dropped by one third of its normal volume at the height of the pandemic (Cano-Valderrama, et al., 2020).
Asia Pacific
The Asia Pacific region was one of the fastest to respond to the COVID-19 pandemic. India, one of the worst hit regions of Asia Pacific, reported a reduction of more than 40% in orthopedic surgeries performed (Vaishya, Vaish, & Kumar, 2021). In Australia, the number of people who were admitted to the hospital for orthopedic trauma decreased by 30% (Probert, et al., 2020). In Japan, elective surgeries were limited to 50% of their usual capacity in 2020 (Kurozumi, et al., 2021).
Middle East & Africa
In the Middle East, the United Arab Emirates imposed tight restrictions on its citizens. Movement restrictions and night curfews were imposed to facilitate disinfection strategies in the region. During the first year of the COVID-19 pandemic, Saudi Arabia reported an orthopedic procedural decline of 35% compared to the previous year’s volume (Sadat-Ali, et al., 2021). Africa was badly hit by the pandemic in 2020, with cases being reported in every country on the continent within three months of the first reported case. South Africa reported a surgical decline of more than 50% during April 2020, compared with the same period the previous year (Waters, et al., 2021).
The latter half of 2020 saw the second wave of national lockdowns as new variants of COVID-19 began to spread. However, by 2021, the rollout of vaccines and more targeted restrictions to reduce the spread allowed procedures to resume. Since then, there have been small surges in cases but no policies put in place causing the industry to close down. As a consequence of vaccination rates, the market has mostly rebounded and is working through the backlog of demand.
Recovery
In most segments of orthopedic soft tissue, procedure rates have returned to their pre-pandemic levels and continue to grow in the forecasted direction.Aside from vaccination rollouts, one of the main factors that has enabled the market to rebound swiftly is that hospitals and surgery centers are already set up to manage and control medical crises. The decrease in procedure numbers was primarily caused by government restrictions on elective surgeries. Recommendations to stop surgical procedures was in the context of the global uncertainty surrounding COVID-19 and its long-term implications, risk of transmission, the insufficient testing capabilities, limited availability of personal protective equipment (PPE) for medical staff and disaster planning to resourcefully prioritize ICU beds and ventilators for the worst affected patients.
In fact, over the past few years, orthopedic soft tissue repair procedures have seen a surgical shift from traditional hospital settings to surgery centers. This proved to be beneficial during the pandemic as surgery center procedures could continue without compromising hospital bed capacity.
Supply Chain Issues
Nevertheless, despite these promising outcomes, the implications of COVID-19 were not contained to 2020.The pandemic revealed some concerning supply chain issues in the healthcare sector. Supply chain issues range from the availability and supply of products to staffing shortages in healthcare settings and delivery services (Gooch & Gonzalez, 2021). Nearly all hospitals and healthcare facilities reported supply chain challenges in 2021 (De Paoli, 2022).
Although they are more prepared to manage these challenges than they were at the beginning of the pandemic, it is expected that there will be continued delays and disruptions to the medical supply chain. To deal with this, hospitals and surgery centers have implemented strategies to mitigate negative consequences as much as possible, such as forecasting product and material requirements, adjusting timelines to accommodate delayed shipping and diversifying their suppliers. However, the effects of these supply chain issues are ongoing and remain a source of concern for healthcare executives and medical manufacturers and distributors.
For the orthopedic soft tissue repair market specifically, segments that contain grafting options may be less affected than those that rely more heavily on fixation devices. For example, in the North American market, grafts are sourced from tissue banks in the United States and are therefore not affected by the added complications and delays associated with importing supplies from overseas. For instance, the Achilles tendon, rotator cuff and ACL/PCL repair and reconstruction segments may be less affected than other segments that rely on internationally manufactured medical devices.
In contrast, surgical procedures of the shoulder labrum, biceps tenodesis, meniscal repair and hip arthroscopy segments rely heavily on fixation devices. While this is cause for some concern in some regions, developing surgical techniques and technological advancements may accelerate the trend towards grafting options where possible.
For example, depending on the severity of the tear and patient needs, hip arthroscopy can be performed using autografts and allografts. However, reliance on allografts may present its own challenges as the demand for donor tendons far exceeds the supply of available allografts.
As the COVID-19 pandemic remains an ongoing crisis, it is assumed that COVID-related volatility will persist and supply chain pressures could negatively impact the market.
The Future Looks Bright
Despite the turmoil of the previous three years, the global orthopedic soft tissue market is projected to grow over the forecast period. The sports industry as a whole, changing demographics and technological advancements are the main drivers of this growth in the market.Sports Industry
Tendon and ligament injuries most commonly occur among professional sports players. Sports medicine manufacturers continue to collaborate with professional sports associations to develop the most up-to-date and clinically approved treatment options. This results in financial support for related research and development activities, clinical trials and studies, as well as educational programs and fellowships.
Demographic Factors
With an ever-aging population trend, mixed with an increasing number of younger patients and active lifestyles, stable growth is expected to continue in the global orthopedic soft tissue repair market. With the increased prevalence of anti-arthritic drugs and pain medication, people are able to maintain active lifestyles at a much older age. This leads to a higher number of elderly patients requiring soft tissue repair and reconstruction treatment.
Technological Advancement
Over the last decade, market development has focused on new materials and surgical techniques. As a result, all-suture anchors and PEEK CF materials have been adopted for soft tissue repair and reconstruction procedures.
The adoption of these materials is also fueled by continuing development of the surgical technique. In addition, synthetic grafting materials reported encouraging outcomes in specific soft tissue repair, driving acceptance in the market. Further development in soft tissue repair techniques and products is expected to benefit from the recent advancement in biomaterials, cell-based technologies, 3D printing and the overall adoption of knee arthroscopy.
Conclusion
Overall, the global orthopedic soft tissue repair market looks set to recover from the initial downturn in procedures caused by the COVID-19 pandemic. The global market is expected to grow moderately over the forecast period. This is largely a consequence of changing demographic factors and continuous innovation in the field of soft tissue orthopedics.References:
1 Barahona, M., Infante, C. A., Palet, M. J., Barahona, M. A., Barrientos, C., & Martinez, A. (2021). Impact of the COVID-19 Outbreak on Orthopedic Surgery: A Nationwide Analysis of the First Pandemic Year. Cureus, 13(8). doi:10.7759/cureus.17252
2 Cano-Valderrama, O., X Morales, X., Ferrigni, C. J., Martín-Antona, E., Turrado, V., García, A., . . . Torres, A. J. (2020). Reduction in emergency surgery activity during COVID-19 pandemic in three Spanish hospitals. British Journal of Surgery, 107(8), e239. doi: https://doi.org/10.1002/bjs.11667
3 De Paoli, A. (2022, March 23). Views From labor to laundry, supply chain issues are impacting the healthcare industry. EBN. Retrieved from https://www.benefitnews.com/advisers/opinion/supply-chain-issues-are-impacting-the-healthcare-industry
4 Gooch, K., & Gonzalez, G. (2021, November 2). Supply chain issues are here to stay: Health leaders share predictions, strategies. Becker's Hospital Review. Retrieved from https://www.beckershospitalreview.com/hospital-management-administration/supply-chain-issues-are-here-to-stay-health-leaders-share-predictions-strategies.html
5 Kurozumi, T., Minehara, H., Kim, J.-W., Oh, C.-W., Miclau, E., & Balogh, Z. J. (2021). Orthopaedic trauma care during the early COVID-19 pandemic in the Asia-Pacific region. OTA International, 4(1). doi:10.1097/OI9.0000000000000119
6 Life Science Market Research. (2022, November 2022). Retrieved from Germany Surgical Procedure Volumes (SPV) Database: https://www.lifesciencemarketresearch.com/procedure-volumes/germany-surgical-procedure-volumes-database
7 Probert, A. C., Sivakumar, B. S., An, V., Nicholls, S. L., Shatrov, J. G., Symes, M. J., & Ellis, A. M. (2020). Impact of COVID-19-related social restrictions on orthopaedic trauma in a level 1 trauma centre in Sydney: the first wave. ANZ Journal of Surgery. doi:https://doi.org/10.1111/ans.16375
8 Rachamin, Y., Meyer, M. R., Rosemann, T., & Grischott, T. (2022). Impact of the COVID-19 Pandemic on Elective and Emergency Inpatient Procedure Volumes in Switzerland – A Retrospective Study Based on Insurance Claims Data. International Journal of Health Policy and Management. doi:10.34172/ijhpm.2022.6932
9 Ribau, A., Vale, J., Xará-Leite, F., & Rodrigues-Pinto, R. (2021). Impact of COVID-19 pandemic and national lockdown in an orthopaedic and traumatology department—a comparison with the homologous period of 2019. Porto Biomed Journal, 6(1). doi:10.1097/j.pbj.0000000000000109
10 Sadat-Ali, M., Al-Dakheel, D. A., Al-Omran, A. S., A, A.-M. S., Al-Sayed, H. N., Bubshait, D. A., & al, e. (2021). Pattern of Orthopedic Trauma during COVID-19 Crisis in Saudi Arabia: Report from Level I Trauma and COVID-19 Center. Journal Musculoskelet Surgery and Research, 5, 262-265. Retrieved from https://journalmsr.com/pattern-of-orthopedic-trauma-during-covid-19-crisis-in-saudi-arabia-report-from-level-i-trauma-and-covid-19-center/
11 Vaishya, R., Vaish, A., & Kumar, A. (2021). Impact of COVID-19 on the practice of orthopaedics and trauma-an epidemiological study of the full pandemic year of a tertiary care centre of New Delhi. Int Orthop, 45(6), 1391-1397. doi:10.1007/s00264-021-05021-5
12 Waters, R., Dey, R., Laubscher, M., Dunn, R., Maqungo, S., McCollum, G., . . . Held, M. (2021). Drastic reduction of orthopaedic services at an urban tertiary hospital in South Africa during COVID-19: Lessons for the future response to the pandemic. South Africa Medical Journal, 111(3), 240-244. doi:10.7196/SAMJ.2021.v111i3.15263
Niamh O’Neill is a research analyst at iData Research. She works on research projects regarding the medical device industry, publishing the U.S Orthopedic Soft Tissue report series.
Kamran Zamanian, Ph.D., is CEO and founding partner of iData Research. He has spent over 20 years working in the market research industry with a dedication to the study of medical devices used in the health of patients all over the globe.