Rotator Cuff Repair

• Continued pain after nonoperative management, is a primary indication for surgery.
• Symptoms such as weakness and shoulder dysfunction that persist for 6-12 months and fail to improve with nonoperative measures.
• Large tears where nonoperative management is not the best option.
• Recent acute injury and severe tears in young, healthy individuals
• For patients with rotator cuff injury who are active in overhead sports work or repetitive activity, surgery may be the best option. In the vast majority of cases, minimally invasive arthroscopic repair techniques are utilized. In rare circumstances with unique injuries, mini-open, or open repair approaches are used.

Rotator cuff surgery may be performed as an open repair, arthroscopic repair, or a combination. The goal of surgery is to reduce pain and restore function. In most cases, minimally invasive outpatient arthroscopic repair is favored because it offers significant benefits while minimizing risk. Benefits include small incisions, less tissue damage, less bleeding, less post-op discomfort, and quicker recovery than open surgery.

The surgical technique selected depends on both the shoulder surgeon’s, Dr. Daniel Kaplan, and the patient’s preference. Typically, rotator cuffs are approached and repaired through minimally invasive arthroscopic surgery. Using an arthroscope (or camera), Dr. Kaplan will examine and treat the tear. It may involve reattaching the tendon to the bone with sutures, suturing the torn ends of the cuff together, or replacing the torn tendon with a graft. Additionally, Dr. Kaplan may remove any bone spurs, smooth the joint surfaces, and debride the joint (clean out loose tendon fragments and other debris inside the joint that can cause restricted motion, irritation, and impingement issues).

Large and complex rotator cuff tears can still be treated with minimally invasive techniques but may require more time or equipment to repair.  In very rare circumstances, specific types of tears may require a combined arthroscopic and open repair technique. Most large tears, particularly in older patients, are, “acute-on-chronic injuries”. This consists of an underlying tendon degeneration combined with an acute injury, causing pain, and enlarging the tear.

Degenerative rotator cuff tears are the most common cause of shoulder pain, weakness, and loss of function and may respond well to nonoperative measures. Nonoperative management can help reduce symptoms and may improve function of the shoulder, but it cannot help the cuff heal or, or halt the progression of the damage.

Shoulder joint replacement surgery may be recommended (instead of tendon repair) when a patient has a large, irreparable rotator cuff tear, arthritis of the joint, as well as the following:

• Severe shoulder pain that interferes with daily activities like reaching, dressing, etc.
• Moderate to severe pain at rest; pain that interferes with sleep.
• Loss of shoulder motion or weakness, and
• Failure to improve with nonoperative measures.