What is a Rotator Cuff Repair? | Shoulder Arthroscopy | Colorado Shoulder Surgeon

In this video, Colorado shoulder surgeon Dr. Peter Millett addresses "What is a rotator cuff repair?" and demonstrates his preferred shoulder arthroscopy surgical approach. The goals of a rotator cuff repair are to restore the normal anatomy, achieve adequate fixation, enhance the healing through bone marrow stimulation, and improve function.

There are certain steps to success:

1. Positioning
- Beach chair position
- Shoulder arthroscopy portals (anterior and posterior)
2. Preparation
- Bursectomy/SAD
- Prepare the footprint adequately
- Perform intra and extra-articular releases as needed
- Mobilize the tear
3. Recognize the tear pattern
- Crescent shape tears are usually compressed back down onto the footprint
- L-shape tears require a type of combination of margin convergence where you bring the tear from posterolateral to anterolateral
- U-shape tears require a combination of releases and convergence
- Massive tears require releases
4. Margin Convergence
5. Place Anchors
- Compress the tendon back down to the footprint of the greater tuberosity
6. Assess Your Work!

Single-row and double-row rotator cuff repair still remains controversial. Colorado shoulder surgeon Dr. Peter Millett prefers the double-row rotator cuff repair. Biomechanial evidence suggests that double-row should perfrom better than single-row due to the improved footprint coverage, improved footprint compression, decreased gap formation and increased load-to-failure using double-row constructs.

With double-row constructs, rotator cuff repairs have now evolved to Transosseous equivalent technique which can be performed either in a knotted or knotless configuration. Dr. Millett's current preference is for a knotless technique in most cases.

In the first case example, a 64 year old male sustained a full-thickness rotator cuff tear. A shoulder arthroscopy knotless double-row bridging technique is used as a rotator cuff repair technique.

The second case was a 68 year old male who sustained a large rotator cuff tear. Dr. Millett used an extended knotless double-row bridging technique using 6 anchors.

The third case was a 55 year old male who sustained a massive rotator cuff tear with small bone fragments. An extended knotless double-row bridging repair using 8 anchors is performed.

Colorado shoulder surgeon, Dr. Peter Millett has performed 105 knotless repairs, with follow-up in 95 shoulders. The mean age was 59.8 years with a minimum follow-up of 24 months. The mean ASES score was 94 and the mean QuickDASH score was 8.4. Overall, these are very good results.

The last case is a 39 year old male who had a failed rotator cuff repair. He underwent extended knotless double-row bridging repair with cuff augmentation. In this case, shoulder arthroscopy will not suffice, so an open repair is performed.

Results from Dr. Millett's practice for a rotator cuff repair using a dermal graft showed excellent results with ASES score increasing from 59 to 90. In summary, shoulder arthroscopy for the treatment of rotator cuff tears:

- Proper indications and patient selection
- Setup and preparation are key
- Adequate releases and tear mobilization as necessary
- Tear pattern dictates repair technique
- Strong fixation
- Early mobilization with post-operative rehab