Rotator Cuff Repair

Overview

Rotator cuff repair is a surgical procedure to reattach a torn rotator cuff tendon to the humeral head. The surgery may be performed arthroscopically, through a mini-open approach, or via open surgery depending on tear characteristics and surgeon preference. The goal is to restore shoulder function and reduce pain by re-establishing the connection between the rotator cuff muscles and the bone.

Indications

This procedure may be considered when:

• •Full-thickness rotator cuff tears causing significant pain or weakness
• •Partial tears that fail to improve with conservative treatment
• •Acute traumatic tears in active individuals
• •Functional limitation affecting work, sports, or daily activities
• •Failed conservative treatment including physical therapy and injections
• •Adequate tissue quality and muscle condition for successful repair

How It Works

The procedure typically involves several coordinated steps:

• •Preoperative evaluation includes MRI to assess tear size, retraction, and muscle quality
• •Surgery is performed under general and/or regional anesthesia
• •Arthroscopic approach uses small incisions and a camera to visualize and repair the tear
• •The subacromial space is examined and any bone spurs may be removed (acromioplasty)
• •The torn tendon edge is prepared by removing damaged tissue
• •Suture anchors are placed into the bone of the humeral head
• •Strong sutures attached to the anchors are passed through the tendon
• •The tendon is secured to its anatomical footprint on the bone
• •Additional rows of fixation may be used for larger tears (double-row repair)
• •Biceps tendon pathology may be addressed concurrently if present

Risks

As with any surgical procedure, potential risks include:

• •Re-tear of the repaired tendon (varies based on tear size and patient factors)
• •Stiffness or loss of range of motion
• •Infection of the surgical site
• •Nerve injury
• •Persistent pain despite successful repair
• •Anchor failure or pullout
• •Blood clots
• •Deltoid muscle weakness (more common with open approaches)
• •Need for revision surgery

Recovery Expectations

Recovery follows a gradual progression:

• •Arm is typically immobilized in a sling for 4 to 6 weeks
• •Passive range of motion exercises begin early under therapist guidance
• •Active motion typically begins after initial healing period (6 to 12 weeks)
• •Strengthening exercises progress gradually over 3 to 6 months
• •Full recovery may require 6 to 12 months or longer
• •Return to desk work may occur within a few weeks with sling
• •Return to manual labor or sports may require 4 to 6 months or longer
• •Compliance with rehabilitation protocols is essential for optimal outcomes

Alternatives

Depending on individual circumstances, alternatives may include:

• •Physical therapy and rehabilitation without surgery
• •NSAIDs and other pain medications
• •Corticosteroid injections for temporary relief
• •Activity modification and lifestyle changes
• •Partial repair or debridement for irreparable tears
• •Superior capsular reconstruction for irreparable tears with intact arthritis
• •Reverse total shoulder arthroplasty for massive irreparable tears with arthropathy

Sources

• AAOS OrthoInfo – Rotator Cuff Tears: Surgical Treatment Options
• Mayo Clinic – Rotator Cuff Surgery
• Cleveland Clinic – Rotator Cuff Surgery
• Johns Hopkins Medicine – Rotator Cuff Repair