Rotator Cuff Repair
Description: Rotator cuff repair is a surgical procedure aimed at repairing all four tendons of the rotator cuff, which can become torn or damaged due to acute injuries, chronic degeneration, or repetitive stress. The rotator cuff comprises four muscles and their tendons: supraspinatus, infraspinatus, teres minor, and subscapularis. These tendons stabilize the shoulder joint and allow a wide range of shoulder movements. When one or more of these tendons are torn, it can lead to pain, weakness, and limited shoulder function. Total rotator cuff repair seeks to restore the integrity of all affected tendons.
Indications for Total Rotator Cuff Repair
Total rotator cuff repair is indicated for patients with:
- Full-thickness tears involving multiple tendons
- Severe partial-thickness tears not responsive to conservative treatments
- Chronic tears with significant symptoms and loss of function
- Acute traumatic tears in active individuals
Types of Rotator Cuff Repair Techniques
There are two primary techniques for total rotator cuff repair:
Procedure:
- Incision: A small incision is made over the shoulder to directly visualize and access the torn tendons.
- Arthroscopic Assistance: An arthroscope is inserted through a small puncture to visualize the tears and guide the repair.
- Tendon and Bone Preparation: Similar to open repair, the tendon edges and bone surface are prepared.
- Tendon Reattachment: Each torn tendon is reattached to the bone using sutures and anchors, with direct visualization through the mini-open incision.
- Closure: The incision is closed with sutures or staples, and the shoulder is bandaged.
Procedure:
- Incisions: Several small incisions (portals) are made around the shoulder to insert the arthroscope and surgical instruments.
- Visualization: The arthroscope, equipped with a camera, provides a clear view of the shoulder joint on a monitor.
- Tendon and Bone Preparation: Specialized instruments are used to debride the torn tendon edges and prepare the bone surface.
- Tendon Reattachment: Each torn tendon is reattached to the bone using sutures and anchors, all performed under arthroscopic visualization.
- Closure: The portals are closed with sutures or surgical tape, and the shoulder is bandaged.
Recovery from total rotator cuff repair involves a structured rehabilitation program to restore shoulder function and strength. The typical recovery timeline includes:
Immediate Postoperative Phase (Weeks 1-2):
- Use of a sling to immobilize the shoulder and protect the repair.
- Gentle passive range-of-motion exercises to prevent stiffness.
- Pain management with medications and ice therapy.
Early Rehabilitation Phase (Weeks 2-8):
- Gradual transition from passive to active-assisted range-of-motion exercises.
- Begin gentle strengthening exercises, focusing on the rotator cuff and shoulder muscles.
- Physical therapy to improve shoulder mobility and function.
Intermediate Rehabilitation Phase (Weeks 8-12):
- Progress to active range-of-motion exercises.
- Increase strengthening exercises for the shoulder and surrounding muscles.
- Focus on restoring shoulder stability and function.
Advanced Rehabilitation Phase (Months 3-6):
- Advanced strengthening and functional training.
- Gradual return to normal activities and low-impact sports.
- Continued focus on shoulder strength, endurance, and flexibility.
Return to Sports (Months 6-12):
- Full return to sports and high-impact activities.
- Ongoing strength and conditioning to prevent re-injury.
While total rotator cuff repair is generally safe and effective, potential risks and complications include:
- Infection
- Stiffness or loss of motion
- Re-tearing of the repaired tendons
- Nerve injury
- Prolonged pain
