Arthroscopic management of rotator cuff disease

Rotator cuff disease (stage 2 impingement, partial-thickness tears, complete cuff tears, and irreparable tears) is as yet only partially understood, and the role of arthroscopy in its management is still under debate. Stage 2 impingement can be managed satisfactorily with arthroscopic techniques. Arthroscopy allows a complete inspection of the glenohumeral joint, enabling the surgeon to diagnose and treat coexisting intra-articular lesions. A thorough bursectomy, coracoacromial ligament resection, and acromioplasty can be performed without the need for deltoid detachment. Arthroscopic technique appears to offer advantages over open technique in the management of partial-thickness tears by allowing accurate inspection of the articular surface of the rotator cuff. The depth and size of the tear can be determined precisely, allowing an appropriate selection of debridement, decompression, and/or tendon repair. The management of complete tears is currently under investigation, with some advocating complete arthroscopic repair and some preferring arthroscopic acromioplasty and "mini-open" repair; there are merits to both approaches. The arthroscopic management of irreparable tears appears to offer the advantages of an open decompression with decreased morbidity. However, the surgeon's ability to accurately determine reparability may be less precise with arthroscopy.