Arthroscopic evaluation and management of rotator cuff tears

The development of arthroscopic techniques has provided the shoulder surgeon with new opportunities to improve the chances of salvaging these difficult rotator cuff tears while generally avoiding the potential disastrous consequences attendant to the open procedures. The arthroscope can be used to review and document the status of the joint and cuff, assess the tear pattern, debride damaged tissues, and smooth the acromion. In addition, a trained shoulder arthroscopist can mobilize the available tissues and repair any viable tendon to bone, without damage to the overlying muscles, through small cosmetic incisions in an outpatient surgery setting. If there proves to be an irreparable injury, debridement and bone smoothing can be readily performed, avoiding iatrogenic injury to the remaining healthy tissues, especially the deltoid muscle. The patient and the surgeon must accept that the arthroscope is merely a helpful surgical tool, a convenient method to visualize the anatomy without damaging other tissues. When one attempts to repair a massive cuff tear, even with the aid of the arthroscope, there are no miracles or magic involved and often the results are less than perfect. Fortunately, once one can see the relevant anatomy, the opportunities to safely repair the tissues are then unprecedented.