What is an arthroscopic rotator cuff repair?

Traditionally, surgical repair of a torn rotator cuff was performed through a 2-3 inch incision. This "open" approach leaves a large scar, requires cutting through the deltoid muscle, and consequently leads to considerable post-operative pain and a slower recovery. Dr. Diaz performs an arthroscopic repair of the rotator cuff, using only 3-4 small, one centimeter long incisions. Smaller incisions mean less pain and lead to a faster recovery and better healing . The deltoid muscle remains intact. "Open cuff repair has been replaced by arthroscopic repair as the gold standard", explains Dr. Diaz. "Advances in instrumentation and fixation have permitted minimally invasive, arthroscopic repair of almost all cuff tears, including large and complex tears."

What does the procedure involve?

Arthroscopic rotator cuff repair is an out-patient procedure carried out using an interscalene block, a type of regional anesthesia. The arm and shoulder are numb and the patient is sedated; general anesthesia is not required. A camera is inserted into the shoulder joint and damaged tissue is identified. Bone spurs and inflamed bursa are removed and rotator cuff repair is carried out. The goal of the surgery is to reattach the torn tendon(s) to the bone using sutures and screw-in anchors. The illustrations below depict Dr. Diaz's preferred technique.

Step 1: The tear is identified and prepared for fixation
Step 2: The pilot hole is made with a "punch"
Step 3: The absorbable screw is inserted
Step 4: The sutures are passed through the rotator cuff tendon
Step 5: Another pilot hole is made with the punch lateral to the "first row". This is the second row of the "double row" repair.
Step 6: Two of the suture tails are passed through the "Pushlock" device prior to insertion.
Step 7 and 8: The sutures are tensioned and the Pushlock is inserted.
Step 9: The final repair construct

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What type of repair does Dr. Diaz use?

Dr. Diaz employs a "double row" or "trans-osseous equivalent" approach in his rotator cuff repairs. This technique produces a larger healing area between tendon and bone. Depending on the size of the tear, the surgery usually takes 45-90 minutes. Visit the photo gallery or surgical video collection to see examples of this technique and its variations.

What happens after surgery?

The patient is discharged home in a sling with a cooling pack and pain medication. Gentle exercises are started on the first post-operative day, and the patient returns to the office on the third day. At this visit, the operative photos are reviewed, physical therapy is prescribed and questions and/or concerns are addressed. The patient returns in one week for removal of sutures by the doctor, and to check the progress of therapy. The arm will be kept in a sling for four weeks after surgery to protect the repair.

Will I see the doctor after surgery?

Dr. Diaz visits his patients in the recovery room after surgery, and will see you on all your post-operative visits. "Not all patients respond similarly to surgery," says Dr. Diaz. "Adjustments in therapy and home exercises, for example, need to be made at each visit in response to the patients progress and their intra-operative findings. Evaluating my patients progress at each post-op visit allows me to fine tune their recovery in a way only the primary surgeon can."

Do all rotator cuff tears require surgery?

No. Many individuals with rotator cuff disease do not require surgical treatment. Physical therapy can be effective for those with smaller, partial thickness tears. If these smaller tears are accompanied by significant inflammation and pain, a cortisone injection will be administered. Full thickness tears, however, are usually best treated with surgical repair.