Arthroscopic Rotator Cuff Repair

Why this approach — at MOS

Rotator cuff repair outcomes depend on two factors above all others: the quality of the initial repair and the quality of rehabilitation that follows. Our approach is to optimize both.

For the repair itself, we favor double-row fixation for medium to large full-thickness tears. The biomechanical data supporting double-row over single-row constructs in terms of footprint restoration and contact area is substantial. For small tears and partial-thickness repairs, a transosseous-equivalent technique or a single medial-row repair is selected based on tissue quality and tear geometry.

We perform every repair under direct arthroscopic visualization, which allows us to identify and address associated pathology — frayed biceps tendons, partial-thickness tears on the articular side, subacromial bursitis, and early labral injury — that might be missed in an open or mini-open approach.

The nerve block placed before surgery is not just for comfort during recovery; it allows us to use less inhalational anesthetic and opioids intraoperatively, which leads to faster, clearer-headed recovery. Patients typically leave the surgery center feeling remarkably comfortable and return to eating and light activity the same evening.

Rehabilitation follows a structured, phase-based protocol coordinated with our in-house physical therapy team. We do not rush the passive motion phase. Tendons heal to bone on a biological timeline that cannot be shortened, and premature active use is the most common cause of repair failure.

Who is a candidate?

Indications

• Full-thickness rotator cuff tear confirmed on MRI
• Partial-thickness tear involving more than 50% of tendon thickness that has failed conservative care
• Acute traumatic tear (e.g., fall on outstretched arm, shoulder dislocation) in an active patient
• Persistent pain, weakness with lifting or overhead activity, or night pain lasting more than 3–6 months despite non-operative treatment
• Functional loss affecting work, sport, or daily activities

Contraindications

• Massive, irreparable tear with significant muscle atrophy and fatty infiltration (may require reverse shoulder arthroplasty instead)
• Active shoulder infection
• Severe medical comorbidities that make anesthesia unsafe
• Patients unwilling to comply with post-operative sling immobilization and physical therapy
• Subscapularis tears in patients with pre-existing severe stiffness (adhesive capsulitis must be addressed first)

Conservative Treatment First

Surgery for a rotator cuff tear is not recommended until non-surgical options have been explored, except in cases of acute complete rupture in young, active patients. The standard non-operative approach includes a structured physical therapy program focused on rotator cuff and periscapular strengthening, activity modification, and anti-inflammatory medications (NSAIDs). Corticosteroid injections can reduce acute inflammation and allow patients to engage in therapy more effectively.

Most partial-thickness tears and many small full-thickness tears in older, lower-demand patients respond well to this approach. Activity modification, postural correction, and targeted strengthening of the infraspinatus and subscapularis can offload the supraspinatus enough to allow meaningful pain relief and functional improvement. Surgery becomes the recommendation when a patient has completed a minimum of 6–12 weeks of supervised therapy without adequate improvement, when imaging shows a large or acute complete tear, or when functional limitations are severe enough to warrant earlier intervention.

The procedure

What Is Arthroscopic Rotator Cuff Repair?

Arthroscopic rotator cuff repair is a minimally invasive surgery that reattaches a torn rotator cuff tendon to the humerus using small anchors and sutures. It is performed through small incisions with a camera. Most patients return to full activity in 4–6 months, depending on tear size.

The rotator cuff is a group of four muscles and their tendons — the supraspinatus, infraspinatus, teres minor, and subscapularis — that stabilize the shoulder and power lifting and rotation. The supraspinatus is the most commonly torn tendon, typically at its attachment point on the greater tuberosity of the humerus. Tears range from small partial-thickness injuries to complete full-thickness ruptures, and large tears may involve multiple tendons.

When a tendon tears, it loses its footprint on the bone. Scar tissue does not restore strength or function. Surgery re-establishes this bone-tendon connection by placing small metal or bioabsorbable anchors in the bone and using the attached sutures to secure the tendon firmly against its footprint while healing occurs.

The arthroscopic approach uses a camera and thin instruments inserted through two to four small incisions, typically 5–10 mm. This avoids the muscle damage of open surgery, reduces post-operative pain, and allows the procedure to be done outpatient — patients go home the same day.

What Happens During Arthroscopic Rotator Cuff Repair?

Before Surgery

You will arrive at the ambulatory surgery center approximately 90 minutes before your scheduled procedure. A pre-operative nerve block — typically an interscalene block — is placed by the anesthesiologist while you are awake but lightly sedated. This numbs the arm and shoulder for 12–18 hours, which significantly reduces post-operative pain and opioid requirements.

Positioning

You are positioned in the beach chair or lateral decubitus position with the operative shoulder accessible to the surgeon. General anesthesia is administered, and the shoulder, neck, and upper arm are cleaned and draped.

Camera Insertion and Joint Inspection

Three to four small incisions (portals) are made around the shoulder. The arthroscope — a pencil-thin camera — is inserted first into the glenohumeral joint (the ball-and-socket) to inspect the labrum, biceps anchor, and articular surfaces. The surgeon then moves into the subacromial space to directly visualize the tear.

Tear Assessment and Preparation

The tear edges are debrided of frayed tissue. The bone footprint on the greater tuberosity is prepared using a burr to create a bleeding surface that promotes tendon healing. The size, shape, and mobility of the tear determine the repair configuration.

Anchor Placement and Repair

Small suture anchors — typically 4.5–5.5 mm titanium or PEEK — are threaded with high-strength sutures and inserted into the bone footprint. The sutures are passed through the torn tendon using a dedicated passing device. For most tears, a double-row repair is used, placing a medial row of anchors through the tendon and a lateral row that compresses the tendon firmly against the bone. This maximizes the contact area between tendon and bone to improve healing.

Associated Procedures

If the long head of the biceps tendon is frayed or unstable, a biceps tenodesis is performed at the same time. Subacromial bone spurs may be removed (acromioplasty) to prevent re-impingement.

Closure and Recovery Room

Portals are closed with sutures or skin tape. The arm is placed in a padded sling. You spend 45–60 minutes in the recovery room before discharge. Most patients go home within two hours of the procedure ending.

Recovery timeline

Frequently Asked Questions