Rotator Cuff Repair
In general, younger patients (<70) with rotator cuff tears do better if they have surgery sooner rather than later. The tissues are stronger, more likely to heal, and less retracted or scarred down. Consequently, we recommend fixing most rotator cuff tears within 4-6 months of discovery for a swifter recovery and more predictable result.
This is outpatient surgery with an arthroscope (a camera used to look into the joint). Three to six small incisions are made around the shoulder to look inside the shoulder joint and in the sub-acromial bursa (the space above the rotator cuff). The surgery is designed to create more room for the rotator cuff by removing the bone spurs from the underside of the acromion and, if possible, to repair the rotator cuff tendons.
A suture anchor is used to repair the tendon back to the bone. These are metal or plastic screws that have thread or suture attached to them. They allow us to reattach tendons to the bone and hold them there while the tendon heals.
Usually we can do this arthroscopically, but occasionally due to the size or kind of tear, we need to make a small incision to fix the tear.
Recovery After Surgery
Physical therapy and your home exercise program are essential parts of your surgical treatment. The physical therapists will work with you throughout the recovery period, starting shortly after your surgery.
A strong repair allows for some gentle motion after surgery, which in turn helps decrease scarring and adhesions (“frozen shoulder”). However, even the best repair is too weak initially for you to raise your arm on your own. Healing of the repaired tendon is slow, and the loads applied to the tendon are large. Each surgeon has his or her own protocol for their patients, but in general:
- 4-6 weeks after surgery: PASSIVE motion only. This means that the other arm can move the operated shoulder, but the muscles in the repaired shoulder must not be used to lift the arm or to rotate it against resistance as this can disrupt the repair. This protects the repair and helps decrease stiffness. For this reason, we usually have you wear a sling during this time.
- 6-8 weeks after surgery: ACTIVE-ASSISTED motion is allowed. This means that, with the help of your other arm, we start letting you use your arm. This is generally when we let you stop using the sling.
- 8-12 weeks after surgery: ACTIVE motion is encouraged. This does not include strengthening exercises.
- Strengthening exercises are often delayed until 3 or more months after the repair, depending on the size of the tear and the quality of the tissue.
Sometimes, the tissue is too thin to hold the suture, or there may not be enough tissue to close the defect. This is like trying to repair a worn-out piece of cloth. Under these circumstances, it may be better to clean up the frayed edges of the tendon and leave all or part of the tear unrepaired. If this happens, we allow you to move your shoulder after surgery to prevent scarring, but the need for post-operative protection is less and is generally determined on an individual basis.
Complications of Surgery
Rotator cuff surgery is less predictable than some of the other procedures we do as orthopaedic surgeons. In general, the results are more unpredictable for older patients with longstanding or larger tears. In these cases, surgery should only be considered after non-operative treatment. Although most patients have significant relief after shoulder surgery, it is not uncommon to have occasional stiffness or soreness in the shoulder after the operation.
The risks associated with shoulder surgery are generally low, but there are some specific complications that can occur:
- Continued pain or stiffness due to scarring in the shoulder
- Non-healing of the rotator cuff (if a repair was attempted)
- Progression of rotator cuff tearing
- Development of acromio-clavicular (AC joint) arthritis
A more general complication of surgery can also occur. These include:
- Deep venous thrombosis (aka “blood clot” or DVT)
- Infection (all patients receive antibiotics at the time of surgery to decrease this risk)
- Nerve injury (associated with numbness, weakness, or paralysis)
- Vascular injury or compartment syndrome
- Complications associated with the anesthesia