1. This Is Typically Outpatient Surgery
You will usually go home the same day as your surgery. If you are older, have more medical problems, had a more difficult tear to repair or had longer anesthesia time, you may be kept overnight for observation.
2. Surgery Is Used to Physically Re-attach the Tendon Back to the Bone
When the rotator cuff tendon tears, it is pulled away from the bone. This is because the muscle that usually pulls on the tendon will keep on pulling, even though the tendon is no longer physically attached to the bone. Over time, the tendon will scar down and the muscle will atrophy, making it more difficult to repair, if at all. That is why I usually recommend that my patients don't wait longer than three to six months to have surgery on a full-thickness tear. With partial thickness tears, you probably have a bit more time because the tension and length of the tendon are somewhat preserved. Physical therapy can help with the pain and weakness from having a full-thickness tear, but remember, only surgery can physically reattach the tendon to the bone.
3. This Can Be Done Through an Open Approach
Your surgeon may perform an open or mini-open repair. Approximately a two-inch incision is made over your shoulder. Usually, an anchor is placed into the bone with sutures coming through it. The tendon is freed up from the scar tissue surrounding it. This is, again, more difficult the longer the tendon has been pulled back. The sutures are brought through the tendon and a knot is tied. This brings the tendon back to the area of bone where the anchor is with the intent that the tendon will heal back to the bone, where it belongs. Part of the surgery is also a subacromial decompression. The bone above the tendon is shaved or burred flat to create more space for the tendon and the sutures.
4. The Surgery Can Be Done Arthroscopically
Today, more rotator cuff repairs are being done with the assistance of an arthroscope. In many ways, the surgeon can actually see more through the scope, than with an open procedure. Either way, the steps are the same as the open procedure, just completed through smaller 1-cm incisions. You will have approximately four or five holes, depending on the size and location of the tear.
5. Full Recovery Is Fairly Long
After surgery, you will be kept in a sling for up to six weeks. During the first part of your rehabilitation, you will be doing passive motion exercises only. Active motion is when you use your muscles to lift your arm. Doing that right after surgery will rip the tendon right back off the bone. Passive motion is done with your other arm, with pendulum exercises and with your physical therapist. Strengthening usually doesn't start until two or three months after surgery. Depending on the size of the tear, it can take up to a full year to fully recover.
