Rotator Cuff Repair

About Rotator Cuff Repair

Rotator cuff repair reattaches torn tendons of the rotator cuff, the group of four muscles and tendons that stabilizes and moves the shoulder, to their footprint on the greater tuberosity of the humerus. The supraspinatus tendon is most commonly involved. Tears may follow injury but are more often degenerative and become increasingly common with age, and many are present without symptoms. Repair is considered for symptomatic tears, particularly acute traumatic tears and those causing weakness. Most repairs are now performed arthroscopically, having largely replaced open and mini open techniques. The torn tendon edge is debrided and mobilized, the bone surface is prepared, and the tendon is fixed to bone using suture anchors in single row, double row or transosseous equivalent configurations. Rehabilitation is lengthy, typically beginning with a period of protection in a sling and passive motion, followed by progressive active movement and strengthening, with improvement continuing over many months. Tendon healing does not always occur, and imaging often shows retears, many of which cause few symptoms. Large tears, chronic retraction and fatty infiltration of the muscle, often graded using the Goutallier classification, are associated with poorer healing. For massive irreparable tears, options include partial repair, superior capsular reconstruction, tendon transfers and reverse total shoulder arthroplasty. Physical therapy without surgery is an alternative for many degenerative tears.