What is Rotator Cuff Repair Surgery?

Rotator cuff repair surgery is the surgical repair of one or more torn rotator cuff tendons, in which the torn tendon is secured back to its normal bone attachment site on the top of the humerus (arm bone). This procedure is typically performed arthroscopically through several small incisions utilizing small, specially designed instruments, implants, and strong stitches or suture material. Arthroscopic rotator cuff repair surgery is commonly undertaken when someone has complete tears of one or more of their shoulder rotator cuff tendons as well as ongoing pain and/or weakness.

Dr. Cunningham is a rotator cuff surgeon at Vail Summit Orthopedics and Neurosurgery. He is an expert at diagnosing and treating rotator cuff injuries for patients in Vail, Summit County, Aspen, and Denver, CO.

When is a Rotator Cuff Repair Needed?

A rotator cuff tear is one of the most common problems affecting the shoulder. It is most commonly seen in patients over the age of 40. It usually does not occur as the result of one, particular injury. Rather, rotator cuff tendons more often tear over time as a result of “wear and tear.”

The rotator cuff is comprised of 4 muscles and their associated tendons that act together to move and power the shoulder. Common conditions that affect the rotator cuff include:

  • Rotator Cuff Tendonitis and Associated Subacromial Bursitis: inflammation of the rotator cuff tendons and the overlying bursa sac is usually caused by chronic, repetitive overhead work or overhead sports.
  • Rotator Cuff Tendon Tearing: The wide range of shoulder motion that the rotator cuff facilitates as well as the high forces that the tendons are subjected to with overhead lifting or overhead sports makes them susceptible to tear over time. Most tears are the result of this “wear and tear.” Less commonly, rotator cuff tears occur as the result of an acute injury or fall. When a rotator cuff tendon tears, it partially or completely pulls away from its normal attachment site on the top of the humerus bone.

Rotator cuff tendonitis, subacromial bursitis and low grade, partial thickness rotator cuff tears are all initially treated with non-surgical methods. These treatments include physical therapy,  which focuses on rotator cuff strengthening exercises, anti-inflammatory medications, and injections if needed. When the rotator cuff muscles are strong, the humeral head is held down in the center of the shoulder socket and the rotator cuff tendons are then less likely to be impinged and inflamed when doing overhead activities.

If there is complete tearing of one or more of the rotator cuff tendons away from their normal bone attachment site, these tears will not heal without surgery. If there is a full thickness tear and if you are experiencing pain and weakness as a result, then arthroscopic rotator cuff repair surgery is reasonable to undergo. In rotator cuff surgery, the torn tendons are freed up from scar tissue, mobilized, and then reattached back to their normal attachment sites on the humerus. The repair is protected and over time the tendons will grow back into the bone. As a result of this healing, one can regain full shoulder motion and strength and resume activities that they could not previously do without severe pain and weakness. Rotator cuff repair surgery is a common procedure that has high levels of patient satisfaction.

How is Rotator Cuff Repair Surgery Performed?

Rotator cuff repair surgery is usually performed arthroscopically. Depending on the exact location, type, and extent of the injury, a specific type of arthroscopic rotator cuff repair surgery will be performed. These procedures include:

  • Rotator Cuff Healing Response Technique: This technique uses the body’s own stem cells and bone marrow to bring healing cells to partially torn and chronically inflamed rotator cuff tendons allowing them to heal. In this technique, the bone is lightly abraded with a burr and the bone is perforated with a small, sharp metal pick in order to bring stem cells and healing elements out of the bone and into the overlying diseased tendon.
  • Arthroscopic, Double Row Rotator Cuff Repair: A rotator cuff tendon attaches over about a half inch wide by 1 inch long area on the top of the humerus bone called its “footprint.” Historically, rotator cuff tendons were repaired using a single row repair technique in which the ends of the tendon were secured down to the edge of the footprint. In double row repair, the tendon is secured back to the entire footprint by placing bone anchors on both the medial and lateral side of the footprint and having intervening sutures bridge across the top of the tendon thus compressing the tendon onto the footprint. Double row repair surgery may have a higher healing rate than single row repair techniques as the fixation of the tendon to the bone is stronger and more anatomic.
  • Superior Capsular Reconstruction: When the rotator cuff tendon on the top of the shoulder (the supraspinatus tendon) is severely torn and retracted such that it cannot be stretched back over to its attachement site on the humerus bone, there is a newer technique in which a donor tendon is used in place of the irreparable supraspinatus tendon. This procedure can be done arthroscopically. The donor tendon helps hold the top of the humerus down into the center of the socket so that the intact rotator cuff muscles and tendons can function better.

In every case, it is the goal of arthroscopic rotator cuff repair surgery to return patients to their active lifestyle and to the sports they enjoy.

What is the Recovery After an Arthroscopic Rotator Cuff Repair Surgery?

This depends on the how many rotator cuff tendons needed to be repaired, how retracted the torn tendons were, and how degenerative or “worn out” the tendons were at the time of the repair.

After undergoing arthroscopic repair of a torn supraspinatus tendon, which is the most common tear seen, patients go home the same day. A sling is worn for 6 weeks. Patients start “pendulum exercises” right away, in which they come out of the sling, bend over, and let the arm dangle and gently swing in a circular pattern by moving their body back and forth and not engaging the shoulder muscles. In this way, the shoulder joint is moved passively and the shoulder muscles are not being engaged so that there is no stress on the repaired tendon. This helps prevent stiffness in the shoulder joint. After doing pendulum exercises for the first 6 weeks, the sling is discontinued and physical therapy is started. In physical therapy, the therapist stretches your shoulder. At 8 weeks from surgery, one can walk their hand up a wall or use a pulley to move the shoulder. By 9 weeks from surgery, patients are allowed to lift the arm overhead under their own power. By 10 weeks from surgery, light strengthening with resistance bands is started. By 12 weeks from surgery, patients have nearly full range of motion, usually no pain, but they are still weak. Full strength may take a 6-9 months to restore, given that one has probably had strength deficits for several years. Following instructions will ensure optimal and timely return one’s active lifestyle.

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How Long Does Rotator Cuff Repair Last?

Once healed, the rotator cuff should not retear. However, returning to repetitive overhead lifting and/or overhead sports can place ongoing stress on the rotator cuff tendons and may lead to tendonitis or possibly a re-tear with time. If a patient is intentional with ongoing care of the shoulder including some ongoing strengthening exercises, then the rotator cuff tendon should not re-tear for the remainder of one’s life. Most patients report satisfaction following rotator cuff repair 10 or more years after surgery. Dr. Cunningham is a rotator cuff surgeon at Vail Summit Orthopedics and Neurosurgery. He is an expert at diagnosing and treating rotator cuff tears for patients in Vail, Summit County, Aspen, and Denver, CO.

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