Surgical procedure in which torn rotator cuff tendons are reattached to the bone with specialized suture anchors. It improves shoulder pain and function.
Indication
- Symptomatic full-thickness rotator cuff tear confirmed by MRI (most often supraspinatus)
- Marked weakness when raising the arm and night-time shoulder pain
- Symptoms not responding to 3-6 months of conservative treatment (physical therapy, NSAIDs, corticosteroid injection)
- Acute traumatic tear (especially in active and younger patients)
- Partial-thickness tears that grow in size or worsen in symptoms
- Limitation of daily activities in an active patient
Preparation
- Detailed shoulder examination, MRI, and ultrasound when needed to assess tear size and tendon retraction
- Two to four weeks of pre-operative shoulder range-of-motion exercises (to prevent stiffness)
- No food or drink for 6-8 hours before surgery
- Blood-thinning medications are stopped with physician approval
- Stopping smoking 2-4 weeks before surgery is important for tendon healing
How it's performed
- General anesthesia is usually given together with a regional (interscalene) block
- The patient is placed in the beach-chair or lateral decubitus position
- Three to four small arthroscopic incisions are made around the shoulder; the joint and subacromial space are inspected
- Suture anchors are placed where the tendon has detached from the bone
- The tendon is reattached to its original anatomic footprint with sutures from the anchors (single-row or double-row repair)
- Associated procedures (acromioplasty, biceps tenodesis) are performed if needed; incisions are closed and the shoulder is placed in a sling
Post-procedure
- Discharge on the same day or after a one-night hospital stay
- Sling is worn for 4-6 weeks; the duration depends on the tear size
- Passive range-of-motion exercises during the first 6 weeks; active-assisted exercises between 6 and 12 weeks
- Physical therapy continues for 3-6 months with a graded strengthening program
- Return to sports or heavy overhead work is possible at 4-6 months; full recovery may take 9-12 months
Risks
- Infection (possible with any surgery)
- Incomplete tendon healing and re-tear (especially with large tears and in smokers)
- Shoulder stiffness (arthrofibrosis) — limited range of motion
- Vascular or nerve injury (rare)
- Anchor pull-out or failure
- Anesthesia-related reactions
FAQ
Is surgery always required for a rotator cuff tear?
Surgery is recommended for acute traumatic tears or in younger and active patients. In older patients with limited activity and degenerative tears, symptoms can be controlled with physical therapy and injections; the decision is individualized.
How long should I keep my arm in a sling after surgery?
A sling is recommended for 4-6 weeks depending on the size of the tear. Passive range-of-motion exercises start during this period. The duration is set according to the surgeon's rehabilitation protocol.
When can I return to sport or work?
Office work can typically be resumed in 2-4 weeks, light physical activity at 3 months, and contact sports or overhead activities (tennis, volleyball, throwing) at 4-6 months. Full recovery may take 9-12 months.
What is the risk of the tendon not healing (re-tear)?
It depends on tear size, age, smoking, and tissue quality. Healing rates are high for small tears; large and chronic tears have a higher re-tear risk. Compliance with the rehabilitation protocol is important.
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