Rotator Cuff Repair

ROTATOR CUFF REPAIR

The rotator cuff is made up of 4 muscles that join together as tendons to cover the “ball” of the upper arm (humeral head). The rotator cuff allows you to initiate lifting and rotation of your arm. Tears of the rotator cuff are fairly common and occur from either an acute injury or from normal wear and tear (degeneration). If a partial tear is identified, a debridement or trimming can often be performed to manage the problem. However, when a complete tear of one or more of the tendons occurs, a rotator cuff repair may be advised.

There are different options available to repair a rotator cuff tear. The open approach has been around the longest and is still used in cases where either a large or complex tear exists. This approach allows the surgeon to visualize the problem directly. Over time, this approach has become less common due to recent advances that allow for less invasive approaches.

A rotator cuff tear may also be repaired arthroscopically. Using this approach, several tiny cuts are made in the skin and a thin camera is inserted into the shoulder joint. This allows the surgeon to confirm the problem and also to correct other defects that may be present. Through the same skin cuts, various types of anchors with threads attached can be placed that allow the surgeon to sew the torn tendons back together again. Some of these anchors are made from materials that are eventually absorbed by the body in time. Anchors can be made of bone, metal or plastic.

The third approach is a mixture of open rotator cuff repair and the arthroscopic approach. Using a mini-open approach, the surgeon typically will introduce the arthroscopy first to evaluate the shoulder and prepare the rotator cuff for repair. Other concerns such as bone spur removal can also be performed at the same time. Once the surgeon has completed the arthroscopic portion, a small incision (usually 3 to 5 cm) is made over the skin and anchors with threads are used to reattach the tendon and bring the torn edges back together.

Each of these options have advantages and disadvantages. Not every patient is a candidate for the less invasive, arthroscopic approach. Newer materials including tissue grafts and injections with growth factors have been developed and continue to advance the treatment for this condition.

As with any surgical procedure, there are risks to having a rotator cuff repair including infection, nerve and blood vessel injuries, bleeding and blood clots. There are also specific risks associated with anesthesia.