Arthroscopic Rotator Cuff Repair

Arthroscopic rotator cuff repair is a minimally invasive surgery to repair an injured or torn rotator cuff using an arthroscope. An arthroscope is a small, fiberoptic instrument consisting of a lens, light source, and camera at its end. The camera projects images of the inside of the shoulder joint onto a large monitor, allowing your surgeon to look for any damage, assess the type of injury, and perform the repair.

The rotator cuff is a group of tendons in the shoulder joint providing support and enabling a wide range of motion. A major injury to any of these tendons may result in a tear. This can occur with repeated overhead use of the arm while playing sports or due to age-related wear and tear. A rotator cuff tear is one of the most common causes of shoulder pain in middle-aged adults and older individuals, and results in weakness of the arm and restricted range of motion.

Indications

Arthroscopic rotator cuff repair is typically indicated for the treatment of symptoms associated with a rotator cuff tear. The most common symptom of a rotator cuff tear is pain that is usually over the outer and front portion of the shoulder. The pain usually worsens with shoulder movement.

In general, your doctor may recommend arthroscopic rotator cuff repair in the following scenarios:

• Your symptoms have lasted for 6 to 12 months
• You have significant pain, loss of function, and weakness in your shoulder
• Your tear is larger than 3 centimeters
• You are an athlete and wish to return to sports soon
• Non-surgical treatments have failed to alleviate symptoms

Preparation

Preoperative preparation for arthroscopic rotator cuff repair may involve the following:

• A thorough history and physical examination
• Routine blood work and imaging
• Refraining from blood thinners, aspirin, or NSAIDs
• Informing your doctor of any allergies to medications, anesthesia, or latex
• Refraining from solids or liquids at least 8 hours prior to surgery
• Arranging for someone to drive you home following surgery
• Signing a consent form after the risks and benefits of the surgery have been explained

Surgical procedure

Arthroscopic rotator cuff repair is usually performed under general or regional anesthesia and involves the following steps:

• Your surgeon makes a few small incisions (arthroscopic portals), about a half-inch in length, over your shoulder joint.
• An arthroscope, a slender tubular device fitted with a light and small video camera, is inserted through one of the incisions into your shoulder joint.
• The video camera transmits the image of the inside of your shoulder joint onto a monitor for your surgeon to determine the amount of damage and type of injury present.
• Miniature surgical instruments are inserted through the other incisions to remove the damaged part of the rotator cuff tendon and injured surrounding tissue.
• The damaged ends of the tendon are sewn together. A suture anchor may be used to reattach a completely torn tendon to the bone.
• Upon completion, the scope and the instruments are withdrawn, and the incisions are closed and covered with a sterile bandage.

Postoperative care

After the surgery, pain medications and antibiotics are prescribed to control pain and prevent infection. You may also apply ice packs on the shoulder to help reduce swelling and pain. Your arm will usually be secured in a sling/immobilizer for 4 to 6 weeks to facilitate healing and protect the repair. The rehabilitation program includes physical therapy, which is started soon after the surgery and is very important to strengthen and provide mobility to the shoulder. You should avoid strenuous activities and lifting heavy weights for a time specified by your doctor or physical therapist. Instructions on surgical site care and bathing will be provided to keep the wound clean and dry. You should be able to perform gentle daily activities a couple of weeks following surgery.

Benefits

The benefits of arthroscopic rotator cuff repair compared to open repair, include the following:

• Smaller incisions
• Minimal soft tissue trauma
• Less pain
• Lower infection rate
• Minimal scarring
• Earlier mobilization
• Shorter hospital stay

Risks and Complications

Arthroscopic rotator cuff repair is a relatively safe procedure; however, as with any surgery, some risks and complications may occur, such as the following:

• Infection
• Bleeding
• Damage to nerves or blood vessels
• Blood clots or deep vein thrombosis (DVT)
• Shoulder stiffness
• Allergic or anesthetic reactions

Summary

Rotator cuff tears are a common cause of shoulder pain in middle-aged and elderly people. They may occur from injury or degenerative changes that occur with aging. Arthroscopic rotator cuff repair can provide significant relief from the pain in most cases, but recovering the functional mobility of the shoulder joint can vary from individual to individual, and depends on active participation in post-surgical rehabilitation exercises.