Rotator Cuff Repair

Procedures

Rotator Cuff Repair

Overview
The rotator cuff is a group of four muscles and tendons that surround the shoulder joint, helping to lift and rotate the arm while keeping the shoulder stable. Over time, these tendons can become weakened or torn due to injury, overuse, or aging. When a tear occurs, patients may experience pain, weakness, and difficulty lifting the arm. Rotator cuff repair surgery aims to reattach the torn tendon to the bone to restore strength, improve function, and relieve pain.

Factors Influencing Rotator Cuff Healing
Several factors impact the success of rotator cuff repair:

  • Size and shape of the tear: Larger or more complex tears may be more challenging to heal.

  • Tissue quality: Healthy tendon tissue improves the chances of successful healing.

  • Timing of surgery: Early repair after injury tends to have better outcomes, as chronic tears may retract and scar over time.

  • Patient factors: Smoking, diabetes, and poor adherence to rehabilitation can affect healing.

The Shift Toward Early Repair and Tissue Preservation
There has been a growing emphasis on early repair for acute, full-thickness rotator cuff tears to prevent tendon retraction, muscle atrophy, and worsening shoulder dysfunction. Repairing these injuries promptly improves healing potential and restores function.

For chronic tears or partial-thickness tears, a trial of physical therapy is typically recommended first. Many patients experience relief with non-surgical management, and surgery is reserved for cases where pain or weakness persists despite conservative treatment.

Whenever surgery is needed, surgeons aim to preserve and repair the patient’s native tissue rather than performing debridement or tendon transfers. Arthroscopic techniques allow precise repair while minimizing soft tissue damage, leading to faster recovery and less postoperative pain.

The Procedure

Rotator cuff repair is typically performed as an outpatient procedure using minimally invasive arthroscopic techniques. Through small incisions, your surgeon inserts a tiny camera and specialized instruments to access the shoulder joint.

During surgery, the torn tendon is carefully mobilized and reattached to the bone using strong sutures and small anchors. Bone spurs or inflamed tissue that may be contributing to the tear are also removed to create an optimal environment for healing.

In some cases, biologic augmentations or grafts may be used to reinforce the repair, particularly in larger or chronic tears.

Addressing Associated Issues
During rotator cuff surgery, your surgeon may also treat associated problems to improve your outcome, such as:

  • Shoulder impingement: Bone spurs or inflamed tissue are removed to create more space for the tendons and reduce friction.

  • Biceps tendon issues: The biceps tendon runs through the front of the shoulder and is commonly involved in shoulder injuries. If it is inflamed or damaged, your surgeon may perform a biceps tenodesis — a procedure that repositions and secures the tendon to relieve pain and prevent it from continuing to cause shoulder symptoms. This allows the biceps to function properly while reducing discomfort.

Addressing these additional conditions at the time of surgery helps improve overall shoulder function and reduces the chance of ongoing pain.

Recovery Process

  • Initial Phase (0–6 Weeks): The shoulder is supported in a sling. Physical therapy focuses on gentle, passive range of motion exercises to protect the repair.

  • Intermediate Phase (6–12 Weeks): Therapy progresses to active motion and begins light strengthening exercises.

  • Advanced Phase (3–6 Months): Strengthening continues with a focus on restoring function and shoulder stability.

  • Full Recovery: Most patients regain good shoulder function by 6 months, with ongoing improvements for up to a year.

Risks and Considerations

  • Risk of incomplete healing or re-tear, particularly in larger or chronic tears.

  • Stiffness or loss of motion if rehabilitation is not followed closely.

  • Infection, bleeding, or nerve irritation (rare).

  • Persistent weakness, especially with very large or complex tears.

  • Possibility of needing revision surgery if the repair does not heal properly.

Conclusion
Rotator cuff repair is a safe and effective procedure to restore shoulder strength and function while relieving pain. If you are experiencing shoulder pain, weakness, or limited motion due to a rotator cuff tear, contact our office for a full evaluation and a personalized treatment plan.