Arthroscopic repair of full thickness cuff tears

April 25th, 2007

The rotator cuff includes four muscles - the supraspinatus, the infraspinatus, the subscapularis, and the teres minor. These muscles cover the humeral head and are largely responsible raising the arm overhead, and rotating the arm side to side. Acute trauma and gradual attenuation are the 2 most common ways that cuff tears develop.

When cuff tears exist but are not painful, there still exists a 50% chance that they will become symptomatic within 3 years. The problem that exists is that if a tear gradually becomes larger over time, or if it retracts--repair may not be possible down the road. Thus, in patient swho are active, full thickness tears are often best treated with repair.

Though open incisions, and mini incisions are popular ways to achieve repair--arthroscopic techniques allow repair with much less pain postoperatively--largely because the work is performed through 3-4 1 cm incisions, only.

Since August 1st , 2005, I arthroscopically repaired 160 rotator cuff tears. My patients' outcomes reflect what has been reported in the literature. When tears are less than 2-3 cm, 90% of patients have great outcomes; when larger than 3 cm—large tears---it drops to between 75 and 85%.

Satisfactory outcome revolves around a combination of surgical skill, compliance with postoperative therapy, and appropriate decision to proceed to surgery in the first place. The newest technique utilizes a "double row repair", which maximizes restoration of the native "footprint". The video/pics show the "suture bridge" construct.

Despite the fact that arthroscopic repair allows full repair with 1 cm incisions, the biology of healing has not changed—patients must be willing to remain in a sling for 6 weeks before beginning an active range of motion program. Active motion starts at 6 weeks, strenghtening at 12 weeks, and full recovery may take between 6-12 months depending on the size of the tear and the quality of the tissue.

Related Photos:

Preoperative MRI image shows a full thickness nonretracted tear of the supraspinatus tendon

Supraspinatus tendon tear

Completed supraspinatus repair with suture bridge technique

Related Videos:

Debridement of the supraspinatus tear

Placement of bioabsorbable suture anchor

Lateral row pushlock anchors complete the suture bridge technique

Footprint reestablished with complete repair

Medial row sutures are tied