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Arthroscopic Rotator Cuff Repair
Dr Kau Chung Yuan (许医生)
MBBS (S’PORE)
MRCS (Ireland)
MMed (Ortho)
FRCSEd (Ortho)
What is Arthroscopic Rotator Cuff Repair?
Arthroscopic rotator cuff repair is a minimally invasive surgical procedure used to fix tears in the rotator cuff, a group of muscles and tendons that surround the shoulder joint. These muscles and tendons provide stability and enable a wide range of motion in the shoulder.
The procedure employs an arthroscope, a small camera, enabling the orthopaedic surgeon to observe the rotator cuff through small incisions, thereby diminishing the necessity for extensive surgical cuts.
When is Arthroscopic Rotator Cuff Repair Needed?
The decision to proceed with arthroscopic rotator cuff repair is based on several factors, including:
- Symptoms and Duration
Patients with symptoms like chronic pain, weakness in the shoulder, and limited range of motion, especially if these symptoms persist despite non-surgical treatments, may be candidates for the procedure. - Severity of the Tear
Significant tears, especially those that are complete or involve more than one tendon, often require surgical repair to restore shoulder function. - Overall Health and Medical History
A patient’s general health and other medical conditions can influence the decision. Surgery is more likely to be recommended for patients who are in good overall health and have fewer risk factors for surgery. - Patient’s Age and Activity Level
Younger patients or those with active lifestyles, including athletes, may benefit from surgery to return to their previous levels of activity. - Patient’s Occupational and Lifestyle Needs
The demands of a patient’s job or daily activities may also influence the decision. For those requiring robust shoulder function for work or sports, surgery might be necessary to regain full functionality. - Response to Conservative Treatments
If conservative treatments such as physical therapy, rest, pain medications, and corticosteroid injections have not provided sufficient relief, surgery may be the next step.
Benefits and Risks of Arthroscopic Rotator Cuff Repair
Benefits
- Minimally Invasive: The arthroscopic approach involves smaller incisions compared to traditional open surgery, which can lead to a reduced risk of infection and quicker healing.
- Less Pain and Discomfort: Patients often experience less postoperative pain and discomfort due to the minimally invasive nature of the surgery.
- Faster Recovery: Recovery time is generally shorter with arthroscopic surgery, allowing patients to return to their normal activities more quickly.
- Improved Shoulder Function: Successfully repaired rotator cuff tendons can restore strength and range of motion in the shoulder.
- High Success Rates: Arthroscopic rotator cuff repair has a high success rate in terms of pain relief and return to function.
Risks
- Surgical Complications: As with any surgery, there is a risk of complications such as infection, bleeding, and adverse reactions to anaesthesia.
- Re-tear of the Tendon: There is a possibility that the repaired tendon may not heal properly or may re-tear.
- Stiffness and Limited Mobility: Some patients may experience stiffness or limited mobility in the shoulder after surgery.
- Incomplete Symptom Relief: In some cases, surgery may not completely alleviate pain or restore full shoulder function.
- Need for Further Surgery: In certain situations, additional surgery may be required, either because of complications or due to incomplete healing of the tendon.
Preparing for Arthroscopic Rotator Cuff Surgery
Preparation for arthroscopic rotator cuff surgery is an important step in ensuring a successful outcome. Patients are typically provided with specific instructions by their orthopaedic surgeon, which may include the following aspects:
- Medical Evaluation
A thorough medical examination, including a review of the patient’s medical history and current medications, to assess fitness for surgery. - Imaging Tests
Imaging tests such as MRI or ultrasound may be conducted to determine the extent of the rotator cuff tear and to plan the surgical approach. - Medication Adjustments
Patients may need to stop or adjust certain medications, especially blood thinners, to reduce the risk of bleeding during surgery. - Fasting
Patients are usually required to fast (not eat or drink) for several hours before the surgery. - Physical Conditioning
Engaging in preoperative physical therapy or exercises, as recommended, to strengthen the shoulder and arm muscles.
What Can You Expect During Arthroscopic Rotator Cuff Repair?
Understanding what occurs during arthroscopic rotator cuff repair can help patients prepare for the procedure. Here is an overview of the typical steps involved:
- Anaesthesia: The procedure is usually performed under general anaesthesia, which means the patient will be asleep and not feel any pain during the surgery.
- Small Incisions: The orthopaedic surgeon makes small incisions around the shoulder joint to insert the arthroscope and surgical instruments.
- Insertion of the Arthroscope: The arthroscope, a thin tube with a camera and light, is inserted to provide a clear view of the inside of the shoulder joint and rotator cuff on a monitor.
- Repairing the Tear: Specialised instruments are used to reattach the torn tendon to the bone. Sutures and anchors may be used to secure the tendon in place.
- Debridement: If necessary, the orthopaedic surgeon may also remove any damaged tissue or bone spurs that could interfere with shoulder movement.
- Continuous Monitoring: Throughout the procedure, the patient’s vital signs are closely monitored by the anesthesiologist.
- Closing the Incisions: After the repair is complete, the incisions are closed with stitches or surgical tape and covered with bandages.
Postoperative Care and Recovery
The period following arthroscopic rotator cuff repair is critical for ensuring a successful recovery and optimal long-term outcomes. Postoperative care typically involves the following components:
Immediate Postoperative Care
- Pain Management: Managing pain with prescribed medications or over-the-counter pain relievers as advised by the orthopaedic surgeon.
- Wound Care: Keeping the surgical site clean and dry to prevent infection. Instructions on how to care for the wound and when to change dressings will be provided.
- Use of a Sling: The arm is usually kept in a sling for a prescribed period to immobilise the shoulder and facilitate healing.
Early Recovery Phase
- Physical Therapy: Starting physical therapy as recommended by the orthopaedic surgeon. Early exercises often focus on gentle movements to prevent stiffness.
- Follow-up Appointments: Attending regular follow-up appointments to monitor the healing process and make any necessary adjustments to the treatment plan.
- Activity Restrictions: Adhering to activity restrictions, including avoiding lifting, driving, or engaging in strenuous activities as directed.
Long-Term Recovery and Rehabilitation
- Gradual Increase in Activities: Gradually resume normal activities as the shoulder heals and strength improves.
- Ongoing Physical Therapy: Continue with physical therapy exercises to restore the full range of motion, strength, and function in the shoulder.
- Lifestyle Modifications: Implementing lifestyle changes, if necessary, to protect the shoulder from future injuries, such as ergonomic adjustments at work or changes in exercise routines.
Patient Feedback
Dr. Kau Chung Yuan
MBBS (S’pore)
MRCS (Ireland)
MMed (Ortho)
FRCSEd (Ortho)
Dr Kau (许医生) is a Fellowship trained Orthopaedic Surgeon with a subspecialty interest in Hip and Knee surgery and has been in practice for more than 15 years.
He is experienced in trauma and fracture management, sports injuries, and joint replacement surgery.
- Fellow of the Royal College of Surgeons Edinburgh, Orthopaedics (FRCS, Edin) 2014
- Master of Medicine (Orthopaedics), Singapore (MMed) 2013
- Member of the Royal College of Surgeons Ireland (MRCS, Ire) 2009
- Bachelor of Medicine and Surgery (MBBS, Singapore) 2004
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Frequently Asked Questions (FAQs)
How long does it take to recover from arthroscopic rotator cuff repair?
The recovery period from arthroscopic rotator cuff repair varies among individuals, but typically, most patients require 4-6 months to fully recover.
Full recovery, defined as a return to pre-injury levels of activity, often occurs within 4 to 6 months, though some patients may continue to improve for up to a year.
Will I experience pain after the surgery?
Postoperative pain is a common experience following arthroscopic rotator cuff repair. The intensity of pain usually decreases significantly within the first few days to weeks.
Ice therapy and rest also play crucial roles in managing pain and swelling. As the healing progresses, the intensity and frequency of pain should gradually diminish.
Can I drive after arthroscopic rotator cuff repair surgery?
The ability to drive after arthroscopic rotator cuff repair surgery depends on several factors, including the side operated on (dominant or non-dominant shoulder), the patient’s overall comfort level, and their ability to control the vehicle safely.
Generally, patients are advised not to drive while their arm is in a sling, and until they can perform necessary driving actions without pain or limitations. This typically entails a waiting period of several weeks post-surgery.