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Dr. Tomaino's Blog

Clinical Update: Improving Outcome after Arthroscopic Rotator Cuff Repair

July 26th, 2008
A number of advances in surgical technique over the past 5 years have improved the outcomes following rotator cuff repair. The pull out strength of anchors, and the use of "suture bridge" double row techniques more reliably ensure contact between repaired tendon and bone.

Despite the minimally invasive appeal of arthroscopic techniques, however, the "biology" of the repair in terms of healing time has not changed. This is the subject of considerable basic research, in an attempt to accelerate healing. As is the case with flexor tendons in the finger, after repair, some ideal level of tension (strain) at the repair site may help to speed up healing and strengthen the repair.

When extrapolating to the rotator cuff tendon repair site, some degree of strain is good, but not at the risk of mechanical failure prior to complete healing. This is precisely why a sling is required for the 1st six weeks following repair, and why active motion is deferred for 6 weeks in most cases.

Regarding the "dreaded sling"---which is unquestionably an inconvenience--a recent paper delivered at the 6th Bienniel AAOS/American Shoulder and Elbow Meeting by Greg Nicholson, MD showed that the use of an abduction wedge/pillow along with the sling improved passive external rotation and flexion for the 1st three months as well as active forward flexion at 6 months.

And so, listen to your Shoulder surgeon when he/she advises compliance with the sling and wedge!! Patients who wear the sling and wedge may require less therapy effort in the early postoperative period and have a higher liklihood of an in tact repair long-term.

At Tomaino Orthopaedic Care we perform rotator cuff repair arthroscopically using the most innovative techniques, and our collaboration with a team of highly skilled therapists makes your recovery our highest priority.


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