Rotator Cuff Repair Overview
The rotator cuff is a system of tendons and muscles located within the shoulder joint. The muscles and tendons connect the upper arm bone (humerus) and the shoulder blade (scapula) to provide stability and assist with movement. The rotator cuff can become injured from sports activities, a fall, repetitive arm movements or degeneration of the rotator cuff tendon. An injury to the rotator cuff can range from mild tendonitis to a complete tear. A surgical rotator cuff repair is typically required in cases that involve a partial or complete tear. Dr. Brian Waterman, Chicago, Westchester, Oak Brook and Hinsdale, Illinois area shoulder surgeon, offers various rotator cuff repair techniques and aids in rotator cuff repair protocols to get patients back to the sports and activities they love.
A rotator cuff injury can cause sharp pain and tenderness within the shoulder joint. In many cases, an injury can heal with conservative measures such as rest, ice, injections and anti-inflammatory medications. If these measures do not alleviate the pain or if a tear is present, Dr. Waterman may recommend a surgical rotator cuff repair followed by a strict guideline of rotator cuff repair protocols. Based on his extensive experience and training, Dr. Waterman is able to offer numerous surgical techniques to repair a damaged rotator cuff, including a ‘single row’ arthroscopic rotator cuff repair, ‘double row’ arthroscopic rotator cuff repair, patch augmentation rotator cuff repair, complex rotator cuff repair and revision arthroscopic rotator cuff repair.
‘Single Row’ Arthroscopic Rotator Cuff Repair and ‘Double Row’ Arthroscopic Rotator Cuff Repair
Patients who have experienced a more severe injury, such as a complete tear, to the rotator cuff may be a candidate for a ‘single row’ arthroscopic rotator cuff repair or a ‘double row’ arthroscopic rotator cuff repair. A ‘single row’ or ‘double row’ refers to the way the tendons are repaired during surgery, either by a single or double row of sutures. Both techniques utilize an arthroscopic approach to help patients return to activities quicker with less pain during recovery.
Patch Augmentation Rotator Cuff Repair
A patch augmentation rotator cuff repair is an effective and safe surgical technique used to provide strength and a positive healing environment for the tendon. After the damaged tendon is repaired arthroscopically, Dr. Waterman will determine if an augmentation will benefit the tendon. If so, a graft (patch) is made from cadaveric dermis (human collagen from skin) and then sewn into the rotator cuff tendon. A repair is then made by the use of strong sutures and anchors into the bone to secure the tendon and graft in place. The concept is similar to repair a hole in your jeans and then placing a patch over the top to provide strength to the repair. The patch provides both improved mechanical strength, and the presence of collagen and other growth factors improves the biologic environment for healing.
Complex Rotator Cuff Repair
If the rotator cuff tear is too large or complex or if additional reconstruction has to be performed, such as a tendon transfer, Dr. Waterman may recommend an open surgery technique. In this technique, Dr. Waterman will make an incision over the shoulder and detach the deltoid muscle to gain access and visibility to the torn tendon. If needed, he will also be able to remove any bone spurs or other structures from the underside of the acromion. In this situation, an alternate tendon is transferred to attach to the humerus and substitute for the torn rotator cuff and help improve function and decrease pain. Commonly used tendons include the latissiums and the pectoralis major.
Revision Arthroscopic Rotator Cuff Repair
If a patient had a rotator cuff repair that hasn’t healed correctly, or has re-torn following surgery, a revision arthroscopic rotator cuff repair may be recommended by Dr. Waterman. The exact revision surgery varies from patient to patient depending on original rotator cuff repair treatment and multiple factors such as size of the recurrent tear, quality of the remaining muscle and tendon, and age and functional demands of the patient. Options for treatment including repeat repair of the tendon using a double row technique, augmenting the repair with a patch and substituting for the re-torn tendon using a tendon transfer, implant or allograft (donor) tissue. In many cases, a patient can expect pain relief, increased shoulder function and a high success rate of the revision surgery if proper rotator cuff repair protocols are followed.
Rotator Cuff Repair Protocols
Dr. Waterman will provide a detailed guideline for all patients to follow after their revision rotator cuff repair. Each patient will have a unique set of rotator cuff repair protocols based on the original injury and surgical procedure. All patients can expect to wear a sling for several weeks to keep the arm immobilized.
Physical therapy is a critical component in the recovery process. It is extremely important that patients follow the advice of Dr. Waterman and the physical therapy team so the rotator cuff repair is not compromised. Typical physical therapy involves a passive range of motion, active range of motion, strengthening exercises and maximum recovery is expected at approximately one year following the procedure.