Arthroscopic Rotator Cuff Repair

The rotator cuff is the thick band of muscles and associated tendons that cover the top of the upper arm and hold in it place, providing support and stability to the shoulder joint. The rotator cuff also allows for a full range of motion while keeping the ball of the arm bone in the shoulder socket. These tendons can become partially or completely torn as a result of a rotator cuff tear or injury. A rotator cuff tear often occurs as a result of injury or overuse of the muscles over a long period of time. Rotator cuff tears typically involve pain when lifting or lowering the arm, muscle weakness and atrophy, and discomfort at rest, particularly if pressure is placed on the affected shoulder.

In most cases, surgery is recommended for tears that cause severe pain or that do not respond to more conservative treatments. Most rotator cuff repair procedures are performed through arthroscopy, which uses a few tiny incisions rather than one large incision. This technique offers patients minimal trauma, less scarring and less damage to the surrounding muscles and tissue. The smaller incisions also result in less pain in the shoulder joint after the surgery.

Arthroscopic Rotator Cuff Repair Procedure

The purpose of arthroscopic rotator cuff repair is to repair the rotator cuff tendon back to the bone that is pulled off from. Sometimes the tendon will split in two, but usually the tendon tears directly off the shoulder bone and must be reattached through arthroscopic surgery. Arthroscopy is a minimally invasive surgical technique that involves making several small incisions and inserting a fiber-optic device (arthroscope) and tiny surgical instruments to repair the torn tendons. Connected to a camera that displays images of the internal structure of the shoulder on a computer screen, the arthroscope allows the surgeon to see the damage and repair the tendons without having to make major incisions.

Risks of Arthroscopic Rotator Cuff Repair

As with any surgery, there are certain risks involved with arthroscopic rotator cuff repair, which may include:

Infection
Pain
Stiffness
Nerve damage
Need for repeated surgery

These complications are rare and most people experience symptom relief with little to no complications after arthroscopic rotator cuff repair

Recovery from Arthroscopic Rotator Cuff Repair

After surgery, the arm is immobilized to promote proper healing. A sling may be recommended to keep the arm from moving for the first several weeks post-surgery. Physical therapy often begins shortly after surgery to help restore strength and movement and allow patients to gradually resume their regular activities. It is important for patients to commit to their physical therapy program in order to achieve the most effective surgical results.

Rotator cuff repair surgery is usually successful in relieving shoulder pain, although full strength cannot always be restored. It is important for patients to commit to their physical therapy program in order to achieve the most effective surgical results. After surgery, physical therapy may be necessary for up to 4 months and full recovery may take up to 6 months. Most patients experience effective pain relief, restoration of function and improved range of motion after their procedure.

Rotator Cuff Injuries

Four muscles in the shoulder that when injured or damaged can lead to sleepless nights, pain, and weakness.

The most common ways of injury to the rotator cuff are trauma, such as a fall on the outstretched hand, repetitive overload to the tendon by activity, or bone spurs cutting into the tendon.

Symptoms commonly begin with pain over the upper arm that is worse with reaching overhead, lying on your side, reaching behind your back, and weakness.

The rotator cuff has a very limited capacity to heal on its own and therefore treatment is often required to improve symptoms. This usually begins with a short period of rest, followed by a rehabilitation program focused on mobility, and strength to improve function. Steroid injection can be used if significant inflammation is present and interferes with the ability to engage in the exercise program. Two thirds of patients will improve with these modalities alone, and thus this is the first phase of treatment.

If symptoms persist, MRI is utilized to evaluate the rotator cuff for tears. Most commonly injured is the supraspinatus tendon. This is the muscle that allows you to put on a jacket, reach into the kitchen cabinet and get out the dishes, put a gallon of milk in the refrigerator, or pour a pot of coffee. Because the tendon is spring loaded, full tears commonly separate or retract. The more the retraction, the more serious the tear. If these tears are not addressed, atrophy will ensue and the tears will frequently get larger over time.

Surgical repair is performed arthroscopically and consists of stretching the tendon back out to it’s attachment point and repairing it back to the humerus greater tuberosity that it pulled off from. Traditionally, the shoulder was immobilized in a sling for up to 6 weeks before starting physical therapy to protect the repair. The downside of this approach was a high rate of postop stiffness, called frozen shoulder. We pioneered an accelerated rehab program for rotator cuff 25 years ago that reduced this immobilization down to just 5 days and actually lowered to postop stiffness rate.

Quality of the rotator cuff tissue has been a major determinant of success of the surgery, as well as the recurrent tear rate. The larger the tear and degree of separation, the higher the recurrent tear rate – that can approach 50 percent!

Innovation in rotator cuff surgery revolves around the use of biologics to reduce the risk of recurrent tears. CuffMend is an acellular, dermal allograft that is placed upon the repair to effectively double the thickness of an atrophic tendon and reduce the risk of recurrent tears. We have been effectively utilizing this technology over the past 2 years with great success to enhance patient outcomes for the most serious tears.

We remain committed to utilizing the best technology to remain innovators in rotator cuff surgery.

Arthroscopic Rotator Cuff Repair