Arthroscopic rotator cuff repair reattaches torn rotator cuff tendons to the humeral head using suture anchors placed through small arthroscopic incisions. The procedure addresses the most common shoulder tendon injury and produces reliable pain relief and functional recovery in appropriately selected patients. Dr. Chudik treats the full range of rotator cuff tears, from small partial tears to massive multi-tendon ruptures.
What Is Arthroscopic Rotator Cuff Repair?
The rotator cuff is the group of four tendons that surround the humeral head and stabilize the shoulder during motion. Tears can occur from acute trauma (fall, lift) or from chronic degeneration, most commonly involving the supraspinatus tendon at its attachment to the greater tuberosity.
Arthroscopic rotator cuff repair restores the torn tendon to its bone insertion using suture anchors. The procedure is performed entirely through small portals, avoiding the larger open incisions and deltoid disruption of older techniques. Two clinical patterns share the same general approach with technical variations:
- Standard Rotator Cuff Repair: addresses the supraspinatus and posterior cuff (infraspinatus, teres minor) tendons that attach to the greater tuberosity. This is the most common rotator cuff repair pattern.
- Subscapularis Rotator Cuff Repair: addresses the subscapularis tendon at its attachment to the lesser tuberosity. The subscapularis is the front of the rotator cuff and is often missed on standard examination and MRI. Its repair requires specific portal placement and biceps tendon assessment.
Who Is a Candidate?
Candidates for rotator cuff repair typically have:
- A full-thickness rotator cuff tear on MRI
- Symptoms (pain, weakness, loss of motion) that interfere with daily activity, work, or sport
- Failure of non-surgical treatment for chronic tears, or acute tears in active patients
- Adequate tendon tissue quality for repair
- A medical profile that allows safe surgery
Massive retracted tears with significant fatty atrophy may not be repairable; these patients are evaluated for superior capsular reconstruction, tendon transfer, or reverse total shoulder arthroplasty depending on age, demand, and rotator cuff arthropathy status.
How the Procedure Is Performed
The procedure is performed through three to four small portals. The arthroscope inspects the joint to confirm the tear pattern, location, and any associated pathology (labral tears, biceps disease, cartilage injury). The bone insertion site on the greater or lesser tuberosity is prepared with a small burr to create a healing surface.
Suture anchors are placed in the bone, typically two to four depending on tear size. Sutures from the anchors are passed through the tendon and tied to reattach it to its native insertion. Modern repair patterns use double-row or transosseous-equivalent constructs that increase the contact area between tendon and bone, improving healing.
For subscapularis repair, the camera and instruments are repositioned anteriorly to access the lesser tuberosity. Biceps pathology is commonly addressed with tenodesis at the same procedure when subscapularis tears are present.
Recovery and Rehabilitation
Recovery follows a protected protocol because the tendon must heal to bone:
- Sling protection for four to six weeks with passive motion within safe limits beginning within days
- Progressive active motion from six weeks
- Strengthening from three months
- Return to overhead activity at four to six months
- Return to heavy overhead work or sport at six to nine months
Subscapularis repair recovery includes additional protection of internal rotation for the first six weeks to allow the repair to heal.
Risks and Outcomes
Risks include re-tear (5 to 30 percent depending on tear size and tissue quality), stiffness, infection, and persistent pain. Re-tear rates are higher for large and massive tears. Outcomes are best when the tear is repaired before significant retraction and tissue degeneration develop.
Pain relief is reliable in most patients. Functional recovery depends on tear size, tissue quality, repair construct, and rehabilitation adherence.
Why Dr. Chudik for Rotator Cuff Repair
Dr. Chudik has performed arthroscopic rotator cuff repair for more than two decades and treats the full range of cuff pathology, from small partial tears to massive multi-tendon ruptures. His clinical research includes development work on suture pin technology used in arthroscopic cuff repair, with US patents covering the surgical method. For massive or irreparable tears, Dr. Chudik also performs superior capsular reconstruction, tendon transfers, and graft augmentation depending on the specific tear pattern.