Rotator cuff repair can often be performed completely through a series of small incisions with the aid of a fiber optic camera. This technique is called shoulder arthroscopy. I perform a majority of my rotator cuff repairs this way. It’s a bit like building a ship in a bottle. I use specialized instruments that help me do all of the same technical maneuvers that I need to perform a secure repair if I was to do the traditional “open” repair.
Shoulder arthroscopy s one of the most revolutionary advances in the treatment of shoulder disorders of the last few decades. It allows surgeons to do operations that were previously not possible with certain added benefits.
There are a many benefits to arthroscopy: but they are not all what you would think.
Less pain. One of patient’s biggest worries about shoulder surgery is that it will be very painful. While no surgery will be totally pain free, rotator cuff repair via arthroscopy may be less painful in the early post operative period than traditional techniques. This is an obvious plus. Less pain means better sleep and a more comfortable recovery.
That’s not to say that you will be totally pain free after an arthroscopic shoulder surgery. Everyone will get some swelling and pain after this procedure. Intermittent ice, sitting upright and taking appropriate pain medication will help decrease the pain.
Lower rates of stiffness. Shoulder surgery can cause stiffness. However, when performed with arthroscopy, rotator cuff repair tends to create less scarring than when performed with traditional open approaches and hence less stiffness.
Low infection risk. Arthroscopic rotator cuff repair has an extraordinarily low infection rate: close to 1/1000
Cosmetics. While even traditional “open” scars can be cosmetic in appearance, arthroscopy incisions tend to be smaller and thus harder to see.
No deltoid detachment. The deltoid is a large shoulder muscle that originates on top of the shoulder blade. Open approaches to the shoulder for rotator cuff repair may involve some detachment of this muscle from its normal bony attachment. At the end of the case it is important for the surgeon to repair the deltoid securely if it is detached. If this repair fails, it can be a significant problem for you.
When you use arthroscopy to repair the rotator cuff you do not have to detach the deltoid muscle and there is virtually no risk of it detaching after surgery. This is a big advantage.
The important thing to remember if you are getting arthroscopic rotator cuff surgery is that it is one of the most technically demanding procedures that orthopedic surgeons perform. And if you are going to have it done, you want to make sure that the surgeon performing your operation performs this operation frequently.
Ultimately the quality of the repair is more important than whether it is done through small or large incisions.
If I had my choice between having my own rotator cuff fixed arthroscopically or “open”, but the surgeon could perform a better repair with an “open” technique, I would pick the open technique 100% of the time.
However, if all other things are equal, arthroscopy offers some unique advantages over open techniques.
When arthroscopy might NOT be in your best interest
In my practice I do most rotator cuff repairs completely with arthroscopy. This includes some very large tears. But in a small number of cases I do “open” rotator cuff repairs with a slightly larger incision. This type of repair actually has a well-studied, excellent long-term track record of improving strength and providing pain relief. Sometimes it’s in your best interest to have a repair done this way. Below are a few reasons why open repair may be right for you.
Some tears are extraordinarily large or scarred and require tissue grafting for augmentation. They may be better served with open techniques.
Revision surgery (repeat surgery) sometimes warrants open techniques. Again, these tears may require more sophisticated tissue treatment for a sound repair.
I personally also use open techniques for most full thickness subscapularis repairs. The subscapularis is the largest and arguably most important of the four rotator cuff muscles. No deltoid muscle detachment is necessary to repair this tendon using open techniques so arthroscopy offers less of an advantage.
Ultimately rotator cuff repair can be performed with either open or arthroscopic techniques. Remember that the quality of the repair is the most important thing. And a quality repair depends on a number of factors not least of which being the skill of the surgeon.
Dr. DiPaola routinely performs arthroscopic rotator cuff operations- more than one hundred per year. He performs arthroscopic rotator cuff surgery on even large tears and is adept at minimally invasive arthroscopic rotator cuff repair. He also has experience treating difficult to manage rotator cuff problems such as large tears, old tears, repeat tears and rotator cuff tears associated with arthritis. If you would like more information or a personal consultation please contact us.