Arthroscopic shoulder surgery for the treatment of rotator cuff tears: why, when and how it is done.

Conclusion

Summary of arthroscopic rotator cuff repair and shoulder surgery for rotator cuff tears, arthroscopic, minimally-invasive and open management

1. Having a rotator cuff tear does not mean that you need to have a surgery; open, arthroscopic, or otherwise.
2. There are many causes of shoulder pain, and many rotator cuff tears can be treated non-operatively, with a comprehensive therapy program to strengthen the muscles around the shoulder.
3. In some cases, surgery is required to restore function of the rotator cuff.  The experienced, specially-trained sports medicine shoulder surgeon can usually treat this problem using specially-designed instruments through small arthroscopic incisions.  Occasionally, an open approach with larger incisions is required.  It is a common misconception that some tears are “too large” to be fixed arthroscopically.  In fact, in experienced hands, the largest rotator cuff tears are the ideal tears to be addressed using arthroscopic techniques.
4. The surgery must be perceived as a process, not an event:  there is a strict postoperative regimen that must be closely followed to assure the success of the procedure.
5. In most cases, the combination of therapy or an outpatient surgical procedure done through the arthroscope will re-establish a functional, comfortable range of motion without pain and allow a person to return to normal overhead activities and even overhead sports and activities such as golf, tennis, and throwing sports.

References

1. Blevins, F. T.; Warren, R. F.; Altchek, D. W.; and et al.: Arthroscopically-assited rotator cuff repair:  Results using a mini-open deltoid approach. Arthroscopy, 12: 50, 1996.
2. Burkhart, S. S.: Arthroscopic treatment of massive rotator cuff tears. Clin Orthop, (390): 107-18., 2001.
3. Burkhart, S. S.: Arthroscopic treatment of massive rotator cuff tears:  Clinical results and biomechanical rationale. Clin Orthop, 267: 45, 1991.
4. Burkhart, S. S.; Danaceau, S. M.; and Pearce, C. E., Jr.: Arthroscopic rotator cuff repair: Analysis of results by tear size and by repair technique-margin convergence versus direct tendon-to-bone repair. Arthroscopy, 17(9): 905-12., 2001.
5. Burkhart, S. S., and Tehrany, A. M.: Arthroscopic subscapularis tendon repair: Technique and preliminary results. Arthroscopy, 18(5): 454-63., 2002.
6. Ellman, H.; Kay, S. P.; and Wirth, M.: Arthroscopic treatment of full-thickness rotator cuff tears:  2-7 year follow-up study. Arthroscopy, 9: 195., 1993.
7. Fealy, S.; Kingham, T. P.; and Altchek, D. W.: Mini-open rotator cuff repair using a two-row fixation technique: Outcomes analysis in patients with small, moderate, and large rotator cuff tears. Arthroscopy, 18(6): 665-70., 2002.
8. Gartsman, G. M.: All arthroscopic rotator cuff repairs. Orthop Clin North Am, 32(3): 501-10, x., 2001.
9. Gartsman, G. M.: Arthroscopic rotator cuff repair. Clin Orthop, (390): 95-106., 2001.
10. Gartsman, G. M.; Khan, M.; and Hammerman, S. M.: Arthroscopic repair of full-thickness tears of the rotator cuff. J Bone Joint Surg Am, 80(6): 832-40., 1998.
11. Hata, Y.; Saitoh, S.; Murakami, N.; Seki, H.; Nakatsuchi, Y.; and Takaoka, K.: A less invasive surgery for rotator cuff tear:  mini-open repair. J Shoulder Elbow Surg, 10: 11-16., 2001.
12. Snyder, S. J.: Evaluation and treatment of the rotator cuff. Orthop Clin North Am, 24: 173, 1993.
13.  Warner, J. J. P.; Goitz, R. J.; Irrgang, J. J.; and Groff, Y. J.: Arthroscopic-assisted rotator cuff repair:  patient selection and treatment outcome. J Shoulder Elbow Surg, 6(5): 463-72., 1997.
14. Weber, S. C.: Arthroscopic debridement and acromioplasty versus mini-open repair in the treatment of significant partial-thickness rotator cuff tears. Arthroscopy, 15(2): 126-31., 1999.

Surgery for Rotator cuff tears, arthroscopic, minimally-invasive and open management at the University of Washington, Department of Orthopaedics and Sports Medicine, Seattle, Washington

Disclaimer

This resource has been provided by the University of Washington Department of Orthopaedics and Sports Medicine as general information only. This information may not apply to a specific patient. Additional information may be found at http://www.orthop.washington.edu or by contacting the UW Department of Orthopaedics and Sports Medicine.

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