Arthroscopic Rotator cuff repair
What is the Rotator Cuff?
The rotator cuff is a group of four tendons and muscles that surround the shoulder joint, holding the ball of the upper arm bone (humerus) in the shoulder socket (glenoid) and enabling you to lift and rotate your arm. Although the muscles comprising the rotator cuff are relatively small sized, they serve to maintain the congruency of the glenohumeral (shoulder) joint and allow the larger muscles such as the deltoid to carry out movements.
Rotator Cuff Tears
A rotator cuff tear is a common injury, often due to degeneration from overuse or aging, but can also occur from acute trauma such as a fall. Symptoms include shoulder pain, weakness, stiffness, and limited range of motion especially significant restriction of overhead activity. Often the patient is unable to lift his/her limb, a condition called as “pseudo-paralysis”. The pathology may present anywhere along a wide spectrum that ranges from degeneration of tendon (“tendinosis”) to complete tears. Patients with long standing rotator cuff tears are at risk of developing Rotator cuff arthropathy where the humerus head subluxes (migrates) superiorly and develops arthritic changes. With advanced age and poor structural quality of the aging tendon, the tears maybe massive in configuration. Some tears that are large in size may require augmentation with biological tissue, a procedure known as superior capsular reconstruction.
Arthroscopic Rotator Cuff Repair
For many rotator cuff tears, arthroscopic surgery is recommended to reattach the tendon to the bone. This minimally invasive procedure uses tiny incisions and an arthroscope (camera) to view and repair the torn tendon.
What patient can expect before surgery?
- Detailed clinical examination to assess shoulder pain, weakness, range of motion, and functional limitations caused by the rotator cuff tear.
- Shoulder X-ray to evaluate bone anatomy, arthritis, bone spurs, and any associated shoulder pathology.
- MRI of the shoulder to confirm the diagnosis, determine the size and location of the rotator cuff tear, and assess tendon quality.
- Assessment of tear severity to identify whether the tear is partial-thickness, full-thickness, retracted, or associated with muscle degeneration.
- Preoperative physiotherapy assessment to evaluate shoulder strength, mobility, and plan rehabilitation following surgery.
- Anaesthesia evaluation to identify any medical conditions that may affect the safety of surgery and recovery.
- Additional investigations such as blood tests, chest X-ray, electrocardiogram (ECG), or other tests as advised by the treating physician and anaesthetist before surgery.
The Procedure
The procedure is generally done under general anesthesia augmented with a regional anesthesia block.
- Small incisions are made in the shoulder area.
- The arthroscope is inserted to visualize the rotator cuff tear.
- Surgical instruments are used to remove any bone spurs and repair the torn tendon.
- The tendon is reattached to the bone using sutures or suture anchors.
- Double-row repair and single-row repair are surgical techniques defined by the configuration of the sutures.
- The incisions are closed with surgical tape or stitches.
Benefits of Arthroscopic Repair
- Smaller incisions, less pain
- Quicker recovery and return to activities
- Advanced arthroscopic techniques allow the repair of larger tears
Recovery and Rehabilitation:
A phased rehab protocol is designed by the therapist that is tailored for each patient. Effective postoperative rehab is essential to maximise outcome. Early rehab focuses on restoring the mobility of the shoulder while allowing the repaired tendon to heal. Later phases of the rehab protocol focus on maximising strength and regaining function. Physical therapy is crucial to regain strength and range of motion through exercise progression over 3-6 months. Driving and return to activities depends on the size of the tear and healing progress.
