Injuries that result from a partial or full tear in one of more of the four tendons that make up the rotator cuff can be repaired arthroscopically. In arthroscopic rotator cuff repair, specialized tools and a small camera are inserted through the small incisions, known as portals, to identify the tear. A specialized tool is used to grasp the torn dense fibrous connective tissue that makes up the tendon and then pulls it back to its reattachment site on the bone. Minor debridement (removal) of scarring tissue and connective tissue adhesions may be required to “release” the tendon so that it is free to move. A small hole is then drilled into the humerus (upper arm bone) and a specialized anchor is inserted and secured into the bone. Sutures attached to the anchor are passed through the torn tendon at several site along the tendon. The sutures are cinched down to secure the tendon to the bone. If the rotator cuff tear is large, specialized sutures will also be used to bring the torn edges of the tendon together before attaching to the anchor. Patients are recommended to wear a sling and immobilize the affected shoulder after surgery. A physical therapy plan is prescribed to regain range of motion and strength in the shoulder. Athletes typically return to full activity after 4-5 months of recovery.
Open shoulder surgery can be used to repair a torn rotator cuff. An incision is made through the skin of the shoulder as well as the deltoid muscle that lies on top of the shoulder. The torn tendon of the rotator cuff is released and then reattached to the bone with sutures that pass through bone tunnels drilled through the humerus (upper arm bone) or with sutures attached to specialized anchors that are inserted into the bone. The sutures are cinched down to secure the tendon to the bone and then the deltoid muscled is stitched back together at the end of the operation. The recovery time and therapy plan for open shoulder rotator cuff repair is similar to the plan for arthroscopic surgery. An open repair is commonly used for a full-thickness (complete) tear of the subscapularis tendon, while most other rotator cuff tears can be effectively repaired arthroscopically.