ROTATOR CUFF REPAIR
The rotator cuff is a group for muscles that surround the shoulder and play a primary role in keeping the proximal humerus (ball) centered within the socket (glenoid) of the shoulder joint. The rotator cuff tendons also enable one to lift his/her arm and rotate his/her arm with strength. Rotator cuff tears are classified into partial-thickness and full-thickness tears. In partial-thickness tears, part of the torn rotator cuff tendon is still attached to the humerus bone. In full-thickness tears, the entire tendon is torn off of the bone.
During surgery, Dr. Keller restores the torn part of the rotator cuff back to its normal position on the humerus bone. There are many different techniques to achieve this goal. Dr. Keller uses a minimally-invasive, arthroscopic technique with either a “single-row” or a “double-row” repair configuration. A single row repair is best for partial-thickness tears or for smaller full-thickness tears. During a single row repair, Dr. Keller places one or two suture anchors (medical screws) in the appropriate position on the humerus bone. He then passes very strong sutures that are connected to the anchors through the rotator cuff tendon and ties strong knots to stabilize the torn tendon back down to the bone.
Dr. Keller recommends a double-row technique for larger rotator cuff tears or tears involving more than one tendon. In a double row technique, Dr. Keller places two or three additional suture anchors adjacent to the single row anchors. After passing the sutures and tying knots from the original row of anchors, Dr. Keller passes the suture limbs over the top of edge of the torn rotator cuff tendon and then tensions down the suture limbs through the second row of anchors. This technique enables to Dr. Keller to compress more healthy tissue down to the bony “footprint.” This double-row technique enables Dr. Keller to expand the surface area of tissue compressed to bone so that the tissue has a better chance to heal. Numerous basic science studies have demonstrated that a double row technique leads to a higher rate of healing of tendon back to the humerus bone when compared to a single row technique.
Following surgery, patients are placed in a sling with a pillow. The pillow positions the arm away from the chest and keeps tension off of the repaired rotator cuff tissue. Dr. Keller recommends intermittent icing and gentle range of motion following surgery. Dr. Kellerrecommends starting physical therapy 2-6 weeks after surgery, depending on the size of the tear and type of repair. Physical therapy focuses on reducing swelling in the shoulder, restoring full range of motion, and eventually, restoring strength to the shoulder. Proper rehabilitation following rotator cuff repair is a steady, sometimes tedious process. It is very important to follow the rehabilitation process carefully to achieve the best outcome.