Rotator Cuff Repair

The rotator cuff is a band of tendons that hold the shoulder in place and prevent overextension. Rotator cuff tears are common shoulder injuries expected to increase with the growth of the aging population. Rotator cuff tears can result from an injury like a fall on an outstretched arm, a sports injury and overuse from repetitive overhead motions found in baseball, tennis, rowing and heavy lifting. Aging tendons wear down and lead to a tear. The risk of a torn tendon due to degenerative wear and tear increases with age.

About rotator cuff tears

Rotator cuff tears may be partial, or complete. Some tears are painful but not all. Some people have pain so serious that it interferes with the basic activities of life like sleep, showering and shopping. For patients with pain, nonsurgical treatment may help but does not provide satisfactory outcomes which can predispose patients to tissue degeneration over time.

Rotator cuff tears are slow to heal and have a high retear rate. Platelet – rich plasma (PRP) therapy with arthroscopic repair of rotator cuff tears decreases the retear rate and improves outcomes. For this reason, Dr. Godin may offer PRP therapy during surgical repair.

When is surgical reconstruction a treatment option?

Surgery is considered when other treatments fail. It can restore shoulder function and help patients return to their lives sooner. Surgery may include removing part of the bone to widen the tendon passage in addition to surgical repair of the torn tendon(s). Most rotator cuff surgery is performed arthroscopically or though small incisions (Mini-open technique).

Who may benefit from rotator cuff repair?

For patients with rotator cuff injury who are active in overhead sports or work, or repetitive activity, surgery may be the best option. In many cases, the patient will have an option for minimally invasive arthroscopic repair, mini-open or open repair.

The surgical repair of a rotator cuff tear is a well-documented option for young, active individuals with acute symptomatic partial and full thickness tears and severe dysfunction. Surgical repair is also a valid option for patients with chronic, symptomatic full thickness tears.

When may rotator cuff repair be recommended?

The type of repair depends on the size of the ear, your anatomy and the quality of your tendon and bone tissues.

Surgical repair may be recommended when:

• The tear is acute caused by a recent traumatic injury. In that case, surgery should be performed within one month of the injury to prevent complications from scarring.
• For patients who need full use of the arm for overhead work or sports.
• For patients who have pain at night which indicates a large full thickness tear
• When the tear is more than 3 centimeters in length and the surrounding tissue is healthy
• For patients who fail to find symptom relief from conservative management for 3 – 6 months.
• For patients with chronic and degenerative tears whose pain lasts 6-12 months Continued pain is a primary indication for surgery.

Rotator cuff surgery

Most rotator cuff surgery is an outpatient minimally invasive arthroscopic procedure with tiny incisions or portals where a miniature camera and surgical tools are inserted into the joint to view and repair the tear. The risks of adverse or serious events associated with surgery are low.

Surgical options include:

• Arthroscopic surgery to reattach the tendon to the head of the upper arm bone using sutures, pins and screws
• Arthroscopic surgery to remove loose pieces of tendon and trimming in a procedure called debridement
• Arthroscopic repair to stitch together the two parts of a complete tendon tear.
• Mini-open surgery involves the use of arthroscopy to assess and treat damage in the joint including bone spurs, and repair of the tendon with a small incision without the use of the arthroscope.
• Open surgery may be indicated for complex tears, for revision surgery and when a tissue graft is necessary.

Recovery

Rehabilitation is the key to full recovery. Up to six months of rehab will help you regain strength and mobility. Complete recovery can take months.

Dr. Jonathan Godin is an internationally renowned orthopedic surgeon whose specialty is complicated joint surgeries. When you or a loved one suffers with an orthopedic injury, contact Dr. Godin at Vail Orthopedic Surgery to schedule a consultation where you will receive the correct diagnosis and state-of-the-art treatments in a caring and compassionate environment.