Arthroscopic Rotator Cuff Repairs

shoulder arthroscopy
Arthroscopic surgery uses a camera to see inside your shoulder joint. John P Kelly / Getty Images

Traditionally, when a patient sustained a rotator cuff tear that required surgical repair, an incision was made over the outside of the shoulder, usually about 6-10 centimeters in length. The muscle beneath the skin was separated to expose the rotator cuff, and the rotator cuff was then inspected and repaired. This is what surgeons call an "open rotator cuff repair."

Unfortunately, this surgical dissection causes significant pain, and can be a persistent problem even after the rotator cuff tear has healed.

More recently, the incisions have become smaller, and a technique called a "mini-open rotator cuff repair" has become more common. In the "mini-open" technique, an arthroscopy is performed on the shoulder. This involves looking at the joint and the rotator cuff with a small camera inserted into the joint, and visualizing this on a television monitor. Much of the work is done with the arthroscope (camera) and small instruments, and the actual repair is done through a small incision, usually about 3-4 centimeters.

Latest Developments

Most recently, techniques have been developed to perform the entire rotator cuff repair with arthroscopic instruments; this is the "arthroscopic rotator cuff repair." Instead of making a larger incision and looking directly at the rotator cuff, the surgeon makes several small incisions (about 1 centimeter each) and works with small instruments while looking at the rotator cuff on a television monitor.

What's all the Fuss About?

Surgeons are always looking for ways to minimize the morbidity (problems) associated with an operation. With a traditional open rotator cuff repair, the surgical dissection can potentially cause pain and disability, despite a good rotator cuff repair. Furthermore, the scar that remains, and the length of rehabilitation are problems that are always the focus of potential improvements in surgical technique.


Arthroscopic rotator cuff repairs cause minimal trauma to the tissues that surround the shoulder and the rotator cuff. Because of this patients have smaller scars and less damage to these nearby structures. Most important of these surrounding structures is the large deltoid muscle over the outside of the shoulder. One potential complication of an open rotator cuff repair is detachment of the deltoid; this potential problem is avoided by the arthroscopic technique.

Some surgeons also believe they can see the rotator cuff much better through an arthroscope, and can maneuver throughout the shoulder joint without the limitations of an incision.


The arthroscopic rotator cuff repair is a more recently developed technique in surgery and there are still conflicting results as to whether or not the repair of the rotator cuff is as good as it is when the surgery is done under "direct visualization." With the "mini-open" rotator cuff repairs, the size of the incision is minimal and the associated trauma is less significant than with a traditional "open" rotator cuff repair. Many surgeons believe that this "mini-open" approach allows much better visualization of the rotator cuff and the repair without the potential problems of an open rotator cuff repair. With the mini-open and open procedures, the surgeon is watching as he or she repairs the rotator cuff tissue.

This so-called "direct visualization" is thought by many surgeons to be necessary to have an adequate repair.

Arthroscopic procedures also have a significant learning curve for the surgeon. Being able to perform the surgery arthroscopically is a skill that takes time to develop. Many surgeons are well qualified to perform this surgery, but you should find out how often your surgeon performs this technique.

Where It Stands

The subject, like many in medicine and surgery, is open to debate. Much of the decision is dependent on your surgeons preferred technique for repairing the rotator cuff. The advent of "mini-open" rotator cuff repairs decreased many of the problems that were seen with traditional "open" rotator cuff repairs. Exactly how much of a benefit the arthroscopic repairs have over a "mini-open" repair is unknown. Furthermore, arthroscopic techniques are not preferred for all patients, and your should discuss individual pros and cons for this surgery with your doctor.

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