• Arthroscopic rotator cuff repair surgery is keyhole surgery of the shoulder
• Not all tears are amenable to repair
• The speed of recovery will depend on a number of factors including the type and size of tear
• Good quality rehabilitation is the key to a successful outcome

Anatomy

The shape of our shoulder ball and socket joint is quite particular in that the socket is flat, and the ball is round. Therefore, the ball relies on 4 tendons that keep it contained in the socket. These tendons are called the rotator cuff tendons. The most commonly affected tendon is the one that lies on the top of the humeral head (the ball) and it is called Supraspinatus.

What does the rotator cuff do?

This when the deltoid muscle attempts to raise your arm by your side or above your head, the Supraspinatus tendon maintains the humeral head (ball) in the socket by pushing it down and into the socket (stabilises it).

The deltoid muscle lifts the arm up whilst the rotator cuff keeps the ball stabilised within the socket.

What happens if the rotator cuff is torn?

When the Suraspinaus (rotator cuff tendon ) is torn then the ball migrates upwards when the deltoid muscle is trying to lift the arm. This is felt as clicking and pain on the side of the shoulder. Sometimes, you feel you need to manipulate your shoulder to get it up (by doing so, you are centering the ball in the socket which means you are trying to subsituting the function of the torn tendon). Once the arm is above your shoulder height it feels easier (less pain) because the ball can position itself in the socket again due to gravity (so it is during the middle of the range of movement that the pain arises).

When the rotator cuff tendon is torn or not working, the humeral head migrates upwards during arm elevation.

Arthroscopic view of a rotator cuff tear

Rotator Cuff Repair

Surgical rotator cuff repair is performed under general anaesthetic with the combination of regional block (this called interscalene block). The surgeon introduces a camera first into the main ball and the socket joint using a small cut at the back of the shoulder and this is done to ensure no other abnormalities are found (this is called diagnostic arthroscopy). After this is done, the camera is then inserted into the subacromial space (that is also done through the same incision and another small cut is made on the side of the shoulder and this is used to pass other instruments that are necessary to perform the repair).

The surgeon places anchors (screws made of metal, plastic or biocomposite material) on the ball and these anchors have strong sutures. The sutures are then passed through the tendon edge which is then pulled down to the ball. Additional anchors are then placed adjacent to the tendon to receive the sutures and the tendon is made snug on the bone (this is called double row repair).

Anchors are placed into the top of the humeral head and sutures are passed through the rotator cuff tendon.

Stitches passed arthroscopically through the rotator cuff.

The sutures are passed over the tendon and into more anchors on the side of the humeral head, fixing the rotator cuff tendon back down onto the bone.

Arthroscopic view of completed tendon repair

After the procedure

When you wake up, your arm will be in a sling that is only required for 4 weeks. Your movements are then restricted to protect the repair, but you will be allowed to move the arm as directed by the surgeon and physiotherapist. After 6 weeks you can drive and move the shoulder in all direction as able, but you should still avoid lifting or loading the shoulder for at least 3 months. It might take a minimum of 3 months before you feel any noticeable improvement from the surgery.