Rotator cuff repair

Rotator cuff repair involves suturing the torn tendon(s) back onto its attachment to the humerus and may be performed either via arthroscopy or open surgery, using sutures and/or bone anchors.

Procedure

• a suture is passed across the long limb of the tear from side to side, using a special instrument, called a suture passer

• the suture is tied and the two ends of the tendon are brought together; this process is then repeated until the long limb of the tear is repaired

• the bone must be decorticated for suture anchors to be inserted, and healing proceeds largely from the bone

• the suture anchor is inserted with a long insertor; the insertor is removed, exposing the sutures which are attached to the anchor

Further suture anchors are added, depending on the size of the tear and steps are repeated for each anchor until the tear is fixed to the bone.

Radiographic features

MRI

Repaired rotator cuff tendons may normally be thin and display high signal for up to a year ³. The Sugaya classification can be used.

Complications

Approximately 25% of patients will experience new pain or loss of function after a rotator cuff repair, primarily from ³:

• rotator cuff re-tear

• impingement

• postoperative synovitis

• hardware failure (e.g. migration)

Factors associated with healing are:

• age <65 years old

• no history of smoking

• acromiohumeral interval >6 mm

• recent tear

• Goutallier classification of rotator cuff muscle fatty degeneration grade 2 or less of the infraspinatus or subscapularis muscle

History and etymology

The majority opinion is that Ernest Amory Codman (1869-1940) performed the first rotator cuff repair in 1909 ^4,5.

See also

• Goutallier classification of rotator cuff muscle fatty degeneration

• acromiohumeral interval

• massive rotator cuff tear