We published a story on Dr. Erik Kubiak, the creator of a new, innovative procedure to repair a rotator cuff, in the October issue of Salt Lake magazine. Inspired by a porcupine quills, Dr. Kubiak's work is so intriguing that we decided to post the story for online readers.

Growing up, Dr. Erik Kubiak never wanted to be a doctor. He wanted to be a fisherman. In his hometown of Kodiak, Alaska, Kubiak was practically raised on commercial fishing boats (we’re talking Deadliest Catch stuff here), and by the age of 17, he could run a boat by himself. Despite a successful career as an orthopedic surgeon, medical educator, researcher and inventor, he still insists, “I never decided not to be a fisherman. When you grow up in a town like Kodiak, all your heroes are fishermen. It’s not the town lawyer or doctor. It’s the guy who brought in the most fish that day.”

But it was his years of growing up on boats, out at sea alongside his heroes, that helped make him a curious, outspoken and tenacious doctor. “Fishing taught me a lot about solving complex problems with limited resources,” he says. “When you are 60 miles offshore, there are no people coming to help. If you have a problem that might sink your boat and land you in the ocean, well, you better fix the problem.”

The confident and lean 40-year-old doctor believes his experience on boats, and his pursuit of extracurricular passions like ice and rock climbing, has given him a broader perspective on the medical field over some of his colleagues who spent most of their lives preparing to become doctors. He prides himself on being able to look at problems from many angles with a solution-oriented attitude. His out-of-the-box approach to medicine has allowed him to question and improve upon the ways doctors reconnect tendons, patch up abdominal wounds and repair damaged rotator cuffs.

And it all started with an ice climbing screw and a porcupine quill.

An Ice-climbing Screw?

When Kubiak was in his residency in New York, he and a few of his colleagues set out to debunk what they perceived to be myths about shoulder surgeries and rotator cuff repair. What he found in his evaluation of the conventional wisdom was startling and frustrating. Startling because the accepted methods of shoulder surgery had an astonishing rate of failure and frustrating because everyone in the orthopedic surgery business knew that but had done nothing to figure out a better method.

“One guy stands up in a national meeting in 1975 and says, ‘This is the way we do [these surgeries],’ and the whole community embraces it like it’s religion for the next 30 years.”

Call Kubiak a heretic then. He had seen similarities between the physics of the rotator cuff technique and, thanks to his athletic inclinations, the physics of ice climbing screws, and set out to test his observation.

According to Kubiak, climbers used to screw ice screws—which are used to anchor climbing ropes into the ice—at a 45-degree angle away from the ground, until an engineer pointed out that the screws should be oriented 45-degrees toward the ground to take full advantage of the load-bearing power of the threads.

“Once we tested it, we found the same principle held true [for rotator cuffs],” he says. “It’s easy to fall into the trap that this is the only thing that works and we don’t need to innovate. Sometimes, in order to innovate, you need to have different experience or have someone from another field look at a problem. Doctors aren’t the best crossover specialists. You spend so long in school that you really don’t have any other experience other than working to become a doctor.”

The Quill’s the Thing

Though Kubiak’s new technique proved to be successful, he came across another complicated component of the surgery for which the conventional solution left him grossly dissatisfied. Tiny strands of tissues, like the fibrous edge of a rug, must be reattached to the top end of the humerus in the shoulder, but they are notoriously difficult to grab hold of. To solve this, doctors have traditionally lassoed all of the ends of the strands together with a loop of surgical thread and pulled them tight. But grabbing the tissue this way stops blood flow, which is key to healing. “So even though it’s wrong, and we know it’s wrong, we keep doing it,” Kubiak says.

Enter porcupine quills. Built with thousands of microscopic barbs that cause them to dig into tissue (like your poor dog’s face), porcupine quills seemed like they might provide the answer. “I thought, ‘What if we could jab a porcupine quill in there,” he says, “and just pull it tight that way?’”

And thus the innovation began. Kubiak and his colleagues started constructing a device that could mimic the two-way action of porcupine quills. At first they simply tried to replicate a quill, but their design evolved into a flexible sheath with barbs on the inside that functions like a Chinese finger trap.

Kubiak tabled the rotator-cuff dilema and turned to another medical conundrum, reattaching cut tendons in a hand. Currently, 30 percent of all tendon reattachments fail and the recovery time for these surgeries is exceedingly long. But Kubiak’s device connects each end of a broken tendon inside the barbed sheath. With the tendons secured this way, patients can start moving their fingers very soon after surgery, and that movement speeds up the healing process. That’s the theory anyway. Right now they know their prototype works, but they need to figure out how to make them on a larger scale. And of course, after that, they need FDA approval.

Kubiak also sees potential for his barbed material to help close large wounds and muscle tears. Muscle can’t be sewn back together, but the material could be used as a patch (think of a bandage with teeth) to pull wounds closed.

“The thing that I enjoy most about the job I do is that there aren’t a lot of good solutions to many problems,” he says. “We have things that are serviceable but not great and they get us by, but I want to look at these problems and find good solutions that will benefit the patient.”