Our Summary

This research paper discusses a surgical method for fixing a torn rotator cuff, a common shoulder injury. The researchers argue that the best approach to this surgery is called an arthroscopic rotator cuff repair (ARCR). They particularly favor a specific technique called a double-row repair, which has been shown to create a stronger, more natural repair. They also use a method known as “knotless suturing” to save time and reduce overall costs. In addition, they sometimes use a double-pulley technique, which provides extra support where needed.

FAQs

  1. What is the gold standard management for rotator cuff repair?
  2. What are the benefits of double-row repairs in arthroscopic rotator cuff repair?
  3. What is the advantage of using knotless techniques in rotator cuff repair?

Doctor’s Tip

One helpful tip a doctor might tell a patient about rotator cuff repair is to follow a proper rehabilitation program after surgery. This may include physical therapy exercises to strengthen the shoulder muscles, improve range of motion, and prevent stiffness. Compliance with the rehabilitation program is crucial for successful recovery and optimal outcomes.

Suitable For

Patients who are typically recommended for rotator cuff repair are those who have a torn rotator cuff that is causing pain, weakness, and limited range of motion in the shoulder. These patients may have tried conservative treatments such as physical therapy and medication without success. The decision to undergo rotator cuff repair is based on the size and location of the tear, the patient’s age and activity level, and the overall health of the shoulder joint. Arthroscopic rotator cuff repair is often recommended for smaller tears, while larger tears may require open surgery. Patients who are motivated to participate in post-operative rehabilitation and are committed to following their surgeon’s instructions are also good candidates for rotator cuff repair.

Timeline

Before ARCR:

  1. Patient presents with shoulder pain, weakness, and limited range of motion.
  2. Orthopedic evaluation and imaging (MRI) confirm rotator cuff tear.
  3. Non-surgical treatments such as physical therapy and corticosteroid injections may be attempted.
  4. Decision is made to proceed with ARCR based on the size and location of the tear.

After ARCR:

  1. Patient undergoes pre-operative evaluation and preparation for surgery.
  2. ARCR is performed using arthroscopic techniques, typically with a suture-bridging double-row repair.
  3. Knotless medial mattress sutures (double-pulley technique) are used for additional support as needed.
  4. Post-operative rehabilitation program is initiated to promote healing and regain strength and range of motion.
  5. Follow-up appointments with the orthopedic surgeon are scheduled to monitor progress and adjust the rehabilitation program as needed.
  6. Over time, the patient experiences improved shoulder function, decreased pain, and increased strength in the affected shoulder.

What to Ask Your Doctor

  1. What is the success rate of arthroscopic rotator cuff repair for my specific injury and condition?
  2. How long is the recovery period after the surgery and what should I expect during the recovery process?
  3. Are there any potential risks or complications associated with the surgery that I should be aware of?
  4. Will I need physical therapy after the surgery and for how long?
  5. What type of rehabilitation program will be recommended for me after the surgery?
  6. How soon can I expect to return to normal activities and sports after the surgery?
  7. Are there any specific precautions or restrictions I should follow during the recovery period?
  8. What are the expected outcomes and long-term prognosis of the surgery for my rotator cuff injury?
  9. Are there any alternative treatment options to consider before undergoing surgery?
  10. How many of these surgeries have you performed and what is your success rate with this procedure?

Reference

Authors: Mancini MR, Horinek JL, Phillips CJ, Denard PJ. Journal: Clin Sports Med. 2023 Jan;42(1):81-94. doi: 10.1016/j.csm.2022.08.004. PMID: 36375872