Surgery is recommended when non-operative treatments have provided minimal or no improvement of your symptoms. Surgery may also be recommended for painful injuries or for people who rely on their arm strength for work or sports. There are several types of surgeries that can be performed for rotator cuff tears. The type of surgery that you have depends on the size, shape, and location of your tear.
Partial rotator cuff tears may only require debridement. This surgical procedure simply trims the tendon. Suturing the tendon together repairs a complete tear. Additionally, tendons can be reattached to the bone. Many of these surgeries can be done as outpatient procedures. You will be anesthetized for the surgery. Three common surgical approaches include Open Surgical Repair, Mini-Open Repair, and Arthroscopic Repair.
Open Surgical Repair is the original type of surgery for rotator cuff tears. During Open Surgical Repair, the surgeon opens the shoulder complex to gain access to the torn rotator cuff. Your surgeon will make an incision over your shoulder and detach a small portion of the deltoid muscle for the surgery. An Acromioplasty is often performed at the same time. An acromioplasty removes bone spurs from underneath the acromion.
A Mini-Open Repair of the rotator cuff is a variation of the Open Surgical Repair. The Mini-Open Repair uses much smaller incisions, typically three to five cm. in length. The deltoid muscle is not detached in this procedure. Instead, the surgeon views and evaluates the joint using an arthroscope.
An arthroscope is a very small surgical instrument. It is about the size of a pencil. An arthroscope contains a lens and lighting system that allows a surgeon to view inside of a joint. The arthroscope can be attached to a miniature camera. The camera allows the surgeon to view the magnified images on a video screen or take photographs and record videotape. With this technology, your surgeon will only need to make small incisions and will not need to open up your joint fully.
The arthroscope is used to remove bone spurs under the acromion and to treat other structures in the shoulder joint. Your surgeon will then use a mini-open incision to repair the rotator cuff. Results of the Mini-Open Repair are equal to the Open Repair surgical method.
Another option for rotator cuff repair is All-Arthroscopic Repair. This technique is commonly used to reconstruct ligaments or remove damaged tissue and bone spurs. Arthroscopy is less invasive than traditional surgical methods. It has a decreased risk of infection and a shorter recovery period.
Your surgeon will make one or more small incisions, about ¼” to ½” in length, near your shoulder joint. Your surgeon will fill the joint space with a sterile saline (salt-water) solution. Expansion of the space allows your surgeon to have a better view of your joint structures. Your surgeon will insert the arthroscope and may reposition it to see your joint from different angles.
Your surgeon may make additional small incisions and use other slender surgical instruments for surgical treatments. Because the surgical incisions are so small, they will require just a few stitches or Steri-Strips. Your surgeon will cover them with a bandage.