Shoulder Rotator Cuff Repair

Rotator cuff repair reattaches a torn shoulder tendon to bone to reduce pain and improve strength and function. Surgery is usually outpatient and is commonly performed arthroscopically.

Indications

Main reasons this surgery is recommended:

• Full-thickness rotator cuff tear with persistent pain and weakness despite appropriate non-surgical care (often 6-12 weeks or longer, individualized).¹
• Acute traumatic tear with new, substantial weakness or loss of active elevation (earlier repair is often considered).¹
• Progressive loss of function, recurrent night pain, or inability to work/sport due to cuff-related symptoms.
• Tear pattern or size judged likely to enlarge or become less repairable if delayed (patient- and imaging-dependent).¹

Common reasons to delay or avoid surgery:

• Absolute: active infection (skin or systemic).
• Relative: poorly controlled diabetes, active nicotine use, severe medical instability, inability to comply with sling protection and rehabilitation, or advanced shoulder arthritis where repair is unlikely to help.¹

Benefits and alternatives

Benefits:

• Reduced pain (especially night pain) and improved daily function.
• Improved shoulder strength with lifting and overhead activities (often incomplete recovery in large tears).
• Potential to slow tear enlargement and tendon degeneration when healing occurs.¹

Alternatives:

• Physical therapy (scapular mechanics, rotator cuff and deltoid strengthening, stretching, posture).
• Medications: acetaminophen; NSAIDs if safe; topical NSAIDs.
• Subacromial or glenohumeral corticosteroid injection for symptom control (timing relative to surgery may matter).¹
• Activity modification, ergonomic changes, and gradual return-to-activity plan.
• For irreparable tears or poor tissue quality: debridement, biceps procedure, tendon transfer, superior capsular reconstruction, or reverse shoulder arthroplasty (selected cases).¹

Surgical procedure

• Performed through small incisions (arthroscopy) and/or a small open incision (mini-open) depending on tear pattern and surgeon preference.
• The torn tendon edge is mobilized; inflamed bursa is cleared to improve visualization.
• Bone at the tendon attachment is prepared to promote healing.
• Suture anchors are placed into bone; sutures are passed through tendon and tied to secure the tendon back to bone.
• Additional procedures may be done as needed (biceps tenotomy/tenodesis, distal clavicle excision, limited acromioplasty, labral debridement).

Key variants: single-row vs double-row repair, and optional augmentation (patch or bioinductive implant) in selected tears.¹

Implant or graft specifics and MRI considerations

• Most repairs use suture anchors (metal, PEEK, or biocomposite). Anchors are intended to remain permanently; removal is uncommon.
• Some tears may use patch augmentation or bioinductive implants to support healing in selected situations.¹
• Most modern anchors/implants are MRI-conditional; MRI is usually possible but may cause artifact near the shoulder. Notify radiology of any implants.

Typical anesthesia

• Most commonly general anesthesia plus a regional nerve block (often interscalene) for early pain control.
• Temporary arm numbness and weakness are common after a block; rare complications include persistent nerve symptoms.
• Most patients go home the same day; overnight stay may be used for medical risk, pain control, or social factors.

Recovery timeline

Recovery depends on tear size, tissue quality, repair tension, and associated procedures. Your surgeon may modify this timeline.

Risks and complications

Common:

• Pain, stiffness, sleep disturbance, bruising/swelling, and temporary numbness around incisions.
• Slow recovery of strength (tendon healing takes months).

Less common:

• Infection (uncommon). Reported deep infection incidence after arthroscopic repair ranges widely across studies (approximately 0.03% to 3.4%); modern large series typically report well under 1%.^5,6
• Re-tear or incomplete tendon healing, especially with large tears, poor tissue quality, older age, and active nicotine use.²
• Persistent pain from arthritis, biceps disease, or nerve-related pain not fully resolved by repair.

Rare but serious:

• Blood clot (DVT/PE). Overall symptomatic VTE after shoulder arthroscopy is low, but risk varies by patient factors and procedure; some systematic reviews report an overall incidence around 0.2-0.3%, with higher rates in rotator cuff repair subsets in some datasets.^3,7
• Nerve injury, major bleeding, fracture, or severe stiffness requiring additional procedures.

Patient-specific risk modifiers:

• Higher risk with active nicotine use, poorly controlled diabetes, obesity, inflammatory disease, immunosuppression, prior surgery, and prior VTE history.^1,7

Durability and revision risk

• Expected longevity depends on tendon healing and ongoing shoulder demands. Many patients maintain improved pain and function for years if the repair heals.
• Imaging-defined re-tear rates at 10+ years vary widely across studies (reported ranges approximately 9.5% to 63.2%), and some patients with imaging re-tear remain clinically satisfied.²
• Reported reoperation/revision rates at 10+ years are generally lower than imaging re-tear rates (systematic review range approximately 3.8% to 15.4% at minimum 10 years, study-dependent).²
• Common reasons for repeat surgery: symptomatic re-tear, stiffness, persistent pain, or infection. Key predictors of failure include large/massive tears, fatty degeneration, poor tendon quality, and nicotine use.^1,2

Practical instructions

• Pain control: multimodal plan (ice, acetaminophen, NSAID if safe, and limited opioid only as needed). Avoid alcohol and sedatives with opioids; do not drive on opioids.
• Constipation prevention if using opioids: hydration, fiber, stool softener, and osmotic laxative if needed.
• Wound care: keep dressings clean/dry; showering depends on closure and dressing; avoid soaking until cleared.
• Sling: wear as prescribed (often 4-6 weeks). Sling is for tendon protection, not just comfort.
• Sleeping: recliner or wedge pillow often helps; keep arm supported.
• Driving: only when off opioids, alert, and able to control the wheel safely; for the operated arm, this is often several weeks and usually after sling discontinuation (surgeon-specific).
• Return to work (typical ranges): desk work 1-3 weeks (if pain controlled and sling-compatible); light duty 6-12 weeks; heavy labor or repetitive overhead work commonly 4-6+ months (individualized).
• Travel/flying: early after surgery, walk every 1-2 hours on long trips, hydrate, and do ankle pumps; follow individualized clot-prevention advice for high-risk patients.⁷
• Red flags (urgent): fever with worsening shoulder pain, increasing redness or drainage, chest pain/shortness of breath, new calf swelling/pain, sudden loss of shoulder function, or uncontrolled pain.

FAQ

1. How much pain is normal? Most pain is highest in the first 2-3 days, then improves; therapy-related soreness is expected.
2. Why do I need the sling so long? It protects the repair while tendon-to-bone healing occurs.
3. When can I shower? When your surgeon clears it based on dressing and incision healing; avoid soaking until cleared.
4. When can I drive? When off opioids and you can safely control the vehicle; commonly after sling restrictions ease.
5. Will an MRI be possible later? Usually yes; tell radiology about anchors/implants.
6. Do I need PT? Yes for most patients; early phases protect the repair, later phases rebuild motion and strength.
7. What are infection signs? Increasing drainage, redness, fever, or worsening pain.
8. What are clot warning signs? Calf swelling/pain, chest pain, or shortness of breath.⁷

Disclaimer: Educational information only; not individualized medical advice. Follow your surgeon-specific protocol, which varies by tear size, tissue quality, and associated procedures.

Bibliography

1. American Academy of Orthopaedic Surgeons. Management of Rotator Cuff Injuries: Evidence-Based Clinical Practice Guideline. Rosemont (IL): AAOS; 2025 Aug 18.
2. Davey MS, Hurley ET, Kang R, et al. Arthroscopic rotator cuff repair results in improved clinical outcomes and low revision rates at minimum 10-year follow-up: a systematic review. Arthroscopy. 2023;39(1):e1-e12.
3. Momenzadeh K, et al. Venous thromboembolism after shoulder arthroscopy: systematic review and meta-analysis. Arthrosc Sports Med Rehabil. 2024.
4. Rees JL, et al. Serious adverse event rates and reoperation after arthroscopic shoulder surgery: population-based cohort study. BMJ. 2022;378:e069901.
5. Mercurio M, et al. Revision surgery for shoulder infection after arthroscopic rotator cuff repair: a systematic review. J Shoulder Elbow Surg. 2024.
6. Singh H, et al. Retrospective analysis of patients undergoing arthroscopic rotator cuff repair yields a 0.11% postoperative infection rate. Arthrosc Sports Med Rehabil. 2021;3(6):e1989-e1995.
7. Triplet JJ, et al. Venothromboembolism following shoulder arthroscopy: a systematic review. Arthrosc Sports Med Rehabil. 2022;4(5):e1779-e1788.
8. Li T, et al. Venous thromboembolism after arthroscopic shoulder surgery: a systematic review. J Orthop Surg Res. 2023;18:115.
9. Werthel JD, et al. Long-term results of revision rotator cuff repair for failed repair. J Shoulder Elbow Surg. 2024.
10. Return-to-sport systematic review: Full-thickness arthroscopic rotator cuff repair demonstrates favorable return-to-sport rates: systematic review. Shoulder Elbow. 2025.