Open Rotator Cuff Repair

Surgery to repair a torn rotator cuff most often involves re-attaching the tendon tothe head of humerus (upper arm bone). A partial tear, however, may need only atrimming or smoothing procedure called a debridement. A complete tear is repairedby stitching the tendon back to its original site on the humerus.Rotator cuff surgery is a common treatment for a torn rotator cuff. Most rotator cufftears are treated without surgery, but there may be situations where surgery is thebest treatment. In some cases, surgery is considered immediately after an injury,while in other situations, surgery is only the last step when all other treatments havefailed. The surgical procedure to repair a torn rotator cuff is sometimes the easiestand most straightforward aspect of treatment, and the rehab and recovery is themost challenging. People having rotator cuff surgery should understand each step ofrehab as a good outcome is highly dependent on the healing and rehabilitation thatfollows surgeryWhen Rotator Cuff Surgery is recommended:You may offer surgery as an option for a torn rotator cuff if your patient,s pain doesnot improve with nonsurgical methods. Continued pain is the main indication forsurgery. If he is very active and use his arms for overhead work or sports, you mayalso suggest surgery.Other signs that surgery may be a good option include:• symptoms have lasted 6 to 12 months• have a large tear (more than 3 cm) and the quality of the surroundingtendon tissue is good• have significant weakness and loss of function in shoulder• tear was caused by a recent, acute injuryThe type of repair performed depends on several factors, including surgeon›sexperience and familiarity with a particular procedure, the size of tear, anatomy, andthe quality of the tendon tissue and bone.The three techniques most commonly used for rotator cuff repair include : openrepair, arthroscopic repair, and mini-open repair. In the end, patients rate allthree repair methods the same for pain relief, strength improvement, and overallsatisfaction.Open Repair: To perform an open rotator cuff repair, the patient is usually placedin a beachchair position, a -3 to -6cm incision is made over the anterior superioraspect of the shoulder, parallel with the lateral border of the acromion, in line withLanger’s lines .The subcutaneous fat layer is then divided with electrocautery and thedeltoid muscle insertion into the acromion is clearly identified. The deltoid is takenoff the anterior aspect of the acromion, generally beginning at the acromioclavicularjoint, extending along the anterior border of the acromion, then splitting the deltoidlaterally for 3 to 5 cm ,Next, a subacromial decompression and bursal resection isperformed. After identification of the leading edge of the tendon, debridement ofadhesions is performed to help mobilize the tendon to the greater tuberosity. Next,bone preparation is performed. In many open rotator cuff repairs, a transosseussuture technique is employed; A locking-stitch technique, known as the modifiedMason-Allen stitch, is often used for better holding power, especially when the qualityof the rotator cuff tissue is compromised. Deltoid reattachment to the acromion is acritical component of open rotator cuff repair.Rehabilitation: postoperative rehabilitation program following rotator cuff repairshould vary based on numerous factors, such as type of surgical approach, size oftear, tissue quality, fixation methods, and patient characteristics. The primary goal ofthe postoperative program is to protect the repair, promote healing, and to graduallyrestore passive motion and muscular strength to gradually restore function.