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.

Figure 3: Arthroscopic Cuff Repair

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.