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Surgery for rotator cuff tear involves suturing the torn muscle to the bone attachment site with the help of suture anchors. These suture anchors are placed like pegs into the bone and have threads passing through them which can be used to tie the torn ends of the rotator cuff. These suture anchors can be made up of metal, bioabsorbable material or thread.
Rotator tears can be repaired through open or arthroscopy (keyhole ) techniques. Open repair is an older technique wherein a bigger incision is required and does not require special set up whereas arthroscopy (keyhole surgery) is a newer technique and requires additional equipment
Arthroscopy uses very small skin incisions so injury to tissue and muscle is minimal and cosmesis is better. The main advantage of arthroscopy is that a surgeon can treat more than one injury during a single sitting because of better visualization and access to the entire shoulder. However, a technically well-performed open surgery can give the same results as an arthroscopic technique
The majority of patients with rotator cuff surgery report good outcomes presenting as decreased pain and improved shoulder function. Apart from the surgical expertise and rehabilitation, success also depends on tendon or tissue quality, size of the tear, poor postop rehabilitation, tendon retraction. Results of surgery are poor in smokers and very elderly patients with preexisting arthritis
An irreparable tear is a rotator cuff tear that was initially a large tear but was neglected to lead to tendon retraction and fatty infiltration leading to poor quality tissue that cannot be mobilized and sutured in its native location during surgery. Surgeons often perform the partial repair in such cases and may discuss the option of a second surgery with such patients
Previously most patients with irreparable tear were treated by masterly inactivity or by partial tear. Recently a new technique of superior capsular reconstruction is showing good results in such patients. This involves taking a sheet of tissue from the patients thigh called fascia lata and use it to reconstruct the superior capsular structure of the shoulder. Patients who have arthritis along with rotator cuff tear are treated with the technique of reverse shoulder arthroplasty which is a type of joint replacement unique to shoulder
Recovery after rotator cuff surgery is dependent on many variables among which patient factors and surgical techniques play a predominant role. Patients are placed on abduction brace for 6 weeks during which only elbow and wrist movements are encouraged. After 6 weeks shoulder movements and strengthening exercises are initiated. Patients recover most of their shoulder function by 3 months by which time the rotator cuff muscle heals completely.
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