What Is Rotator Cuff Surgery?

Rotator cuff surgery refers to a procedure that is performed to repair a group of torn tendons that are responsible for the major functions and movements of the shoulder joint.

Because the rotator cuff is basically a group of tendons that comes together to form the covering of, and are attached to, the upper portion of the humerus, they cannot heal by themselves when significantly torn or detached.

Rotator cuff repair surgery is performed in either an open fashion, arthroscopically, or a combination of the two.

Open Rotator Cuff Repair

• There are essentially two types of rotator cuff surgery that are being performed today: the "open" cuff repair and the "arthroscopic" cuff repair. There is. however, a variation that actually incorporates both of these types in that the shoulder first undergoes and arthroscopic examination and "cleanup", followed by a "mini-open" version of the cuff repair.

  The open procedure does not utilize arthroscopic examination. It consists of making an incision over the anterior/lateral portion of the shoulder and separating parts of the deltoid muscle to expose the cuff tear. Once exposed, the torn edges of the rotator cuff are reattached to the bone of the humerus using sutures, suture "anchors" or both.

  The muscle is repaired and the incision is closed. The arm is typically placed into a shoulder immobilizer for several weeks to ensure proper healing. Activity is resumed in a very strict and gradual manner utilizing specific physical therapy protocols.

Arthroscopic Cuff Repair

• This type of surgery involves the repair of the rotator cuff strictly through the small stab wound "portals" that are used to perform the arthroscopic portion of the procedure, and under direct vision through the arthroscope.

  There are no incisions per se, only portals. Specifically designed instruments and techniques are used to prepare the bone, insert bone anchors, pass sutures, tie knots and repair the cuff, all through this minimally invasive technique.

  Benefits include reduced post-operative pain because of the absence of large incisions and lack of muscle dissection, and a shorter hospital stay (typically out-patient).

Arthroscopy With "Mini-Open" Cuff Repair

• This technique involves performing a shoulder arthroscopy for examination and basic debridement and cleanup work; bone shaving, bursa sac removal and other assorted tissue trimming.

  Upon completion of the arthroscopic portion of the surgery, a somewhat smaller incision is made over the anterior/lateral portion of the shoulder and the cuff tear is exposed for repair.

  The repair is virtually the same in all approaches, using suture anchors and is no different here.

  The beauty of a "hybrid" procedure such as this allows for work to be done in spaces that are normally inaccessible in an "open" surgical environment, but allowing the surgeon the tactile benefit of repairing the cuff openly.

Fixation of the Cuff Tear

• The rotator cuff tissue must be sufficiently reattached to the bone of the humerus to promote proper and strong healing. If this is not done correctly, the tissue will not heal to the bone and the procedure will fail.

  The most common way to reattach the rotator cuff tissue to the bone is by way of "suture anchors." These implantable devices are small, corkscrew-shaped metallic tips that are literally "screwed" into the bone. Sutures of varying materials are connected to these anchors through small "eyelets" in the anchor, allowing the suture to slide during knot-tying. These anchors also come in "bio-absorbable" materials as well.

Post-Operative Treatment

• Following rotator cuff repair, the arm is typically placed into a shoulder immobilizer, which maintains the arm and shoulder in a particular position of decreased tension on the repair. Most movements of the shoulder are restricted for several weeks, at which time gentle strengthening programs are begun. Too much active movement too early can cause the sutures and anchors to fail, resulting in a doomed surgery and possibly the need for repeat repair.