Arthroscopic Rotator Cuff Repair: Indication and Technique

Shoulder arthroscopy and rotator cuff repair techniques are frequently used by most practicing orthopaedic surgeons. A thorough patient history and physical examination can often confirm the presence of a rotator cuff tear, and imaging can be used to evaluate the extent of the injury. The indication for rotator cuff repair is a painful shoulder refractory to nonsurgical management. Arthroscopic techniques, including capsular and coracohumeral ligament releases to decrease tension on the repair, facilitate successful rotator cuff repair. Biomechanically, a double-row transosseous-equivalent rotator cuff repair provides excellent results for medium-size rotator cuff tears. Larger, retracted rotator cuff tears may be better repaired with oblique convergence sutures and a medial single-row rotator cuff repair. The biology of healing, the preservation of blood supply, and the trephination of the bony healing bed are essential parts of all rotator cuff repair procedures. Protection of the rotator cuff repair with an abduction sling for 4 to 8 weeks postoperatively and the delay of active motion until early healing has occurred will improve outcomes.