Arthroscopic Repair of Full - Thickness Rotator Cuff Tears : Surgical Technique and Instrumentation

Volume 7 • Number 1 of 2 • 2001 Orthopedic Special Edition 25 R otator cuff tears can be effectively treated with acromioplasty and stable repair of the tendon to the tuberosity of the humerus. Rotator cuff surgery reliably decreases pain, and improves motion and function as well as the general health status of the patient. The operative approach for rotator cuff repairs has evolved from the classic open approach to a miniopen, or deltoid-sparing, approach, then finally to an “all-arthroscopic” repair. The surgical evolution has been stimulated by an improved understanding of rotator cuff tear patterns,as well as the availability of arthroscopic instrumentation specifically designed for soft tissue repair techniques. Furthermore, surgical concepts such as margin convergence have provided repair strategies that allow the shoulder arthroscopist to treat any rotator cuff tear, regardless of its size or retraction, with arthroscopic methods that are equal to open methods when evaluating the clinical result. The ability to repair the rotator cuff without detachment or manipulation of the deltoid is a tremendous benefit to the patient, offering decreased pain associated with the cuff repair, avoidance of complications related to deltoid reattachment, and optimization of the rehabilitation process. With arthroscopic rotator cuff repairs, the rate-limiting step for recovery is biologic healing of the rotator cuff tendon to the humeral bone (estimated to be a minimum of 8 to 12 weeks), and the time required to strengthen the rotator cuff muscles once biologic healing is achieved. This discussion will focus on the concepts related to arthroscopic repair of rotator cuff tears involving the supraspinatus and infraspinatus tendons.