Arthroscopic Rotator Cuff Repair

The Goal

Dr. Kevin Wall provides specialized, fellowship-trained surgical treatment for Rotator Cuff Tears to restore function and relieve pain for patients in Richmond, VA, and the surrounding Central Virginia communities. The goal of this procedure is to reattach a torn rotator cuff tendon to its native footprint on the humerus to restore the strength and mechanics of the shoulder. Not all tears are the same; they range from small, acute tears in young athletes to massive, retracted tears in older patients. Therefore, the surgical strategy is highly individualized. Whether it involves a straightforward repair or a complex reconstruction of a scarred, retracted tendon, the objective remains the same: to create a stable, tension-free repair that allows for biologic healing and a return to overhead function.

For more information on this topic, see the American Academy of Orthopaedic Surgeon's educational page here.

For an example video of this procedure, see the American Academy of Orthopaedic Surgeon's educational page here.

The Procedure

  • The Approach: Performed entirely arthroscopically using small incisions. Dr. Wall evaluates the specific tear pattern—Posterosuperior (supraspinatus/infraspinatus) versus anterior (subscapularis)—to determine the best fixation method.

  • Repair Constructs:

    • Single-Row Repair: Often used for smaller, partial, or less retracted tears where one row of anchors provides sufficient stability.

    • Double-Row Repair: For larger tears, Dr. Wall typically utilizes a double-row technique. This involves two rows of anchors that compress the tendon against the bone, maximizing the contact area for healing and increasing mechanical strength.

  • Complex Tear Management:

    • Releases & Slides: In chronic cases where the tendon is scarred and retracted, Dr. Wall performs "interval slides" and releases. By freeing the tendon from surrounding scar tissue, it can be mobilized and brought back to the bone without excessive tension.

    • Partial Repair: If a massive tear cannot be fully completely closed due to poor tissue quality, a "partial repair" is performed to restore the anterior and posterior "force couples." This rebalances the shoulder and can significantly improve function even if the defect isn't 100% closed.

    • Suprascapular Nerve Decompression: In cases of massive retraction or distinct muscle weakness, the suprascapular nerve may be compressed by a cyst or tight ligament. Dr. Wall can release this nerve arthroscopically during the repair to relieve pain and aid in muscle recovery.

  • Concurrent Procedures:

    • Biceps Tenodesis: As the long head of the biceps is often damaged alongside the cuff, it is frequently addressed with a biceps tenodesis to eliminate a primary pain generator.

    • Arthroscoic Debridement: Any loose fraying or inflammatory tissue is removed to clean up the joint environment.

Post-Op Protocol

  • Immobilization (Phase 1: 0–6 weeks): A sling is required.

    • Small/Medium Tears: You may begin formal physical therapy at Week 2 for passive range of motion. Weaning from the sling begins at Week 4.

    • Large/Massive Tears: To protect the repair, you will remain in the sling for 6 weeks with no shoulder motion allowed (only elbow/wrist/hand). Formal therapy typically begins at Week 6.

  • Phase 2 (6–12 weeks):

    • Motion: Progression from passive to active-assisted (AAROM) and active range of motion (AROM).

    • Lifting: For standard repairs, light lifting (1–2 lbs) may begin around Week 6–8. For massive tears, lifting is restricted until the tendon has healed further.

  • Phase 3 (12–16 weeks):

    • Strengthening: Once full range of motion is achieved, strengthening exercises begin.

    • Goal: Re-establishing scapular control and rotator cuff endurance.

  • Phase 4 (16+ weeks): Return to labor-intensive work or recreational sports is typically cleared between 4 and 6 months, depending on the tear size and strength recovery.

When to Seek Care

You should schedule a consultation if:

  • You have pain that consistently wakes you up at night.

  • You have true weakness (difficulty lifting your arm), not just pain.

  • You experienced a sudden "pop" or immediate loss of strength after an injury.

  • You are over the age of 40, had a recent shoulder dislocation and now have shoulder pain and weakness.