Rotator cuff repair

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Rotator cuff repair

The rotator cuff is a group of four muscles and their tendons that stabilize the shoulder joint and allow for smooth and controlled arm movements. These muscles are: Supraspinatus, Infraspinatus, Teres minor, and Subscapularis. Together, they form a cuff over the head of the humerus (upper arm bone) and keep it firmly within the shallow socket of the scapula (shoulder blade).

The repair of a tear in the rotator cuff tendons (supraspinatus, infraspinatus, teres minor and subscapularis) is carried out as an all-arthroscopic procedure via tiny incisions over the shoulder. The repair is performed using special devices called suture anchors. Depending on the size of the tear (small to massive rotator cuff tear), it may need a single anchor or up to five-six anchors. When necessary a single-row to double-row repair technique is used to get a robust repair. There is small risk of re-tear of the repaired tendon, this will depend on the quality of the tendon tissue. In the case of poor-quality tendon tissues, our specialists prefer to perform augmented rotator cuff tear, where the repair is augmented with a biological tissue patch to increase the chance of healing (Augmented rotator cuff repair). In some instances a re-tear in the repaired tendon can happen due to injury, in which case, our specialists may recommend revising the repair (Revision rotator cuff repair) to improve shoulder function.

Surgical Techniques for Rotator Cuff Repair

Rotator cuff repair can be performed using different surgical techniques depending on the tear size, location, and surgeon preference:

  1. Arthroscopic Repair
  • Minimally invasive
  • Performed through small incisions using a camera (arthroscope) and specialized instruments
  • Less pain, quicker recovery
  1. Mini-Open Repair
  • Small incision over the shoulder
  • Combines arthroscopy for assessment and open repair for tendon stitching
  1. Open Repair
  • Traditional method with a larger incision
  • Used for complex or massive tears
  • May involve tendon transfer or reconstruction if needed

What does arthroscopic rotator cuff repair involve?

  • Rotator cuff repair is performed arthroscopically (key-hole surgery) with stab incision around the shoulder joint (Arthroscopic rotator cuff repair). This procedure is performed under combination of general and regional anaesthesia.
    • In this procedure, a camera is introduced into the joint, through which the whole joint is inspected first.
    • Following the diagnostic arthroscopy, the torn tendon is freed of adhesions or degenerative tissue and then stitched back to the bone with the synthetic sutures and anchors. The anchors are small hard pellets (usually plastic) with tails of strong suture material that are fired into the bone in the humeral head. The suture tails are passed through the tendon and then tied down. Depending on the tear pattern, the surgeon may opt for single row or double row repair.
    • The operation will also involve removing some bone from the underside of the bony arch (acromion) which is positioned just above the rotator cuff tendons (Subacromial decompression). This prevents the bony arch from rubbing on the tendons and repair when the shoulder is moving.

    One may also need

    • removal of the biceps tendon from the shoulder (Biceps tenotomy or Biceps tenodesis)

    removal of the joint between the collar bone and shoulder-blade (Distal clavicle Excision).

Clinical Pathway

  • You will be seen by the specialist in outpatient department for clinical evaluation.
  • You will be asked certain questions related to your symptoms and examined thoroughly.
  • Your investigations such as X-ray, MRI will be reviewed, following which a surgical plan of surgery will be made.
  • A detailed explanation will be given to you with regards to surgery along with its pros and cons.
  • You will be seen by the anesthetic team
  • Your fitness for surgery will be evaluated.
  • Investigations including blood tests will be carried out.
  • A physical therapist will explain you with regarding to the post op precautions, exercises and immobilization.
  • You will be admitted on the day of surgery in the morning. The surgery will be performed under general and regional anesthesia.
  • After surgery, you will be under certain medication to control your post operative pain to make you comfortable.
  • You will be discharged on the same or next day with post operative instructions.
  • Your physical therapy will be started on the next day after surgery and will continue for around three months.
  •   You will be required to see the specialist in outpatient clinic on couple of occasions to assess the recovery. You were expected to recover completely in approximately three to six months

FAQ

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Causes of Rotator Cuff Tears
Rotator cuff tears may be partial (tendon frays or is damaged but not completely torn) or full-thickness (complete tear). Common causes include: • Trauma or injury (e.g., fall on an outstretched arm) • Repetitive overhead activities (common in athletes or manual laborers) • Age-related degeneration • Poor blood supply to the tendons • Bone spurs that irritate the tendon
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Indications for Surgery
The rotator cuff repair is performed for tear in the rotator cuff tendon. You will considered a candidate for repair if you have  severe pain in the shoulder enough to affect your function  night pain  poor strength in performing activities  no improvement with non-operative measures such as physical therapy, injections, painkillers.
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Preoperative Evaluation
Before surgery, the following assessments are typically performed: • Physical exam to test range of motion and strength • Imaging: MRI, ultrasound, or X-ray to evaluate tear size and muscle condition • Medical clearance if other health conditions are present
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Hospital stay duration
The patients are usually discharged on the same day of surgery or the next day once they are comfortable.
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Precautions after surgery
Following surgery, you will be advised post op rehabilitation where a sling will be applied to support the arm for 4-6 weeks along with supervised exercise regimen under guidance of a physiotherapist which starts the next day of surgery.
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Risks and Complications
Vast majority of the patients will get their shoulder back to normal following surgery and rehabilitation. We do see some complications such as stiff shoulder or re-tear of the repaired tendon, fortunately, they occur in only small percentage of patients. This again depends on multiple factors such as the extent of the tear or the chronicity of symptoms, the quality of tendons, age, quality of bone, and how well one has followed the rehabilitation program. Moreover, not all the patients with re-tear need a revision surgery. Even with re-tear patients will gain benefit from the operation as the shoulder will be much less painful although one may not regain all your strength.
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Recovery and Rehabilitation
Usually the patients would be able to move their shoulder freely without pain in about 2 to 3 months. However, the strength in the shoulder takes almost 4-6 months to improve. Timeline: 0–6 Weeks: • Arm immobilized in a sling • Passive range of motion exercises (performed by a therapist or assisted) • No active shoulder use 6–12 Weeks: • Start active-assisted and then active range of motion exercises • Gradual strengthening exercises 3–6 Months: • Advanced strengthening • Return to light activities 6–12 Months: • Full recovery (depending on tear size and adherence to rehab) Rehabilitation Goals: • Prevent stiffness and frozen shoulder • Gradually regain strength and mobility • Avoid re-tear or reinjury If you're considering rotator cuff surgery or supporting someone who is, understanding the full recovery process and engaging in rehab is just as critical as the operation itself.

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