If your shoulder pain and weakness do not improve with nonsurgical methods, your doctor may recommend surgery to reattach and repair the torn rotator cuff tendon. The type of surgery your doctor decides is best will depend on several factors, including the size of the tear and quality of the tendon tissue. There are generally three types of rotator cuff repair procedures – traditional open repair, arthroscopic repair and mini-open repair.
In the case of a severe rotator cuff tear, shoulder replacement may be recommended; specifically, Reverse Shoulder Replacement. The specific design of the reversed implant allows for the stronger deltoid muscle to take over for the rotator cuff for function and mobility.
In traditional open repair, the surgeon makes an incision a few inches long in the shoulder, and moves aside the shoulder muscle (deltoid) to view the torn tendon. Then the surgeon will generally remove any scar tissue or debris in the area and reattach the tendon using anchors and sutures to affix the tendon to the bone.
With an arthroscopic repair, a small video camera called an arthroscope is inserted into the shoulder through a tiny incision in the shoulder. The arthroscope displays magnified images of the shoulder joint on television monitors. The surgeon then inserts thin arthroscopic instruments, which are about the size of a pencil, through other small incisions and uses them to remove excess tissue and reattach the tendon.
In a mini-open repair, the surgeon uses arthroscopy to view the tear and treat any damage to the surrounding area within the joint. Because the surgeon does this part of the procedure arthroscopically, it avoids the need to detach the deltoid muscle. Once this is complete, the surgeon creates small incisions, about 3 to 5 cm long, and reattaches the tendon by viewing the rotator cuff area directly, rather than on the video monitor.