Rotator Cuff Repair

The rotator cuff is a group of muscles and tendons that surround the shoulder joint, keeping the head of the humerus (upper arm bone) firmly within the shallow socket of the shoulder. Rotator cuff repair is a surgical procedure used to repair a torn rotator cuff.

Types of Rotator Cuff Repair

• Open Repair: This traditional method involves making a large incision over the shoulder to access the damaged tendon or muscle. The surgeon then sews the torn tendon back onto the bone using sutures and anchors.
• Arthroscopic Repair: This minimally invasive procedure uses a small camera (arthroscope) and specialized instruments inserted through several tiny incisions around the shoulder joint. The surgeon views the damaged area on a monitor and performs the repair using smaller instruments.
• Mini-Open Repair: A combination of arthroscopic and open techniques, where a smaller incision is made to assist with the repair after initial arthroscopic evaluation.

Surgical Techniques

The goal of rotator cuff repair surgery is to reattach the torn tendon to the humerus bone. Various surgical techniques may be employed, including:

• Single-Row Repair: One row of anchors and sutures is used to secure the tendon to the bone.
• Double-Row Repair: Two rows of anchors and sutures are used for a stronger repair, especially in larger tears.
• Transosseous-Equivalent (TOE) Repair: A technique that aims to recreate the natural tendon-bone interface using suture anchors and a specialized stitch pattern.

Postoperative Care and Rehabilitation

After surgery, patients typically undergo a period of immobilization in a sling to protect the repair. A structured rehabilitation program follows, which includes:

• Pain Management: Medication and ice are used to manage pain and inflammation.
• Passive Range of Motion (PROM) Exercises: Gentle exercises to maintain shoulder mobility without active muscle use.
• Strengthening Exercises: Progressively introduced to improve muscle strength around the shoulder joint.
• Functional Activities: Patients are gradually reintroduced to daily activities and sports-specific movements under the guidance of a physical therapist.

Risks and Complications

As with any surgical procedure, rotator cuff repair carries potential risks and complications, including:

• Infection
• Nerve damage
• Bleeding or hematoma
• Re-tear of the tendon
• Stiffness or decreased range of motion

Outcomes and Expectations

The success of rotator cuff repair surgery depends on various factors, including the size and location of the tear, patient age, and compliance with postoperative rehabilitation. Generally, patients can expect:

• Improvement in pain levels
• Enhanced shoulder function and mobility
• Return to pre-injury activities, although this may take several months to a year or more.