Double Row Arthroscopic Rotator Cuff Repair Overview
A double-row arthroscopic rotator cuff repair for rotator cuff injuries is an arthroscopic shoulder surgery that can improve the overall quality of the rotator cuff restoration process.
The double row arthroscopic procedure is a newer technique in arthroscopic surgery and has become increasingly popular due to improved instruments, surgeon skill and comfort level. Dr. Peter Millett performs the double row arthroscopic surgery on patients who have more severe rotator cuff tears or when this type of repair is needed to provide extra stability for their specific tear.
What is a Rotator Cuff Repair for Severe Rotator Cuff Tears?
This technique uses minimally-invasive, keyhole surgery to repair torn rotator cuff tendons. Arthroscopic rotator cuff repair is not only less invasive, but also decreases the risks of post-operative complications such as muscle injury, stiffness, or infection. Double-row repair refers to an anatomic restoration of the original rotator cuff ‘footprint’ (the exact size, shape and makeup of the rotator cuff). A single-row arthroscopic rotator cuff repair surgery, while effective for many patients, does not re-establish the normal footprint anatomy. The double-row technique uses keyhole surgery to repair the tendons to their natural anatomy using a double-row of sutures rather than just a single row.
While more technically challenging for the surgeon, ‘double row’ creates a more secure repair and is less painful for the patient who will have an overall better potential for healing of the torn tendons.
After Double-Row Arthroscopic Rotator Cuff Repair
The rotator cuff tendon repair needs 4-6 weeks to heal so active motion of the shoulder is not permitted during this time. Physical therapy will usually begin after your first visit to us and will consist of passive motion performed by the therapist. In some cases we will allow you to use water therapy where your arm will be weightless. You will need to wear your sling for 4-6 weeks. After this period you will begin a program of active motion and eventually strengthening. Below is a checklist of what to expect.
- It is normal to have swelling, discomfort and pain in the shoulder area following rotator cuff surgery for a week or more. Apply ice bags or use the icing machine you were given to control swelling. Ice should be applied 20-30 minutes at a time, every hour or so. It helps to put a thin towel or T-shirt next to your skin if using ice in a plastic bag. Icing is most important in the first 48 hours, although many people find that continuing it lessens their post-operative pain.
- If you had a nerve block during surgery, the local anesthetic may keep your shoulder numb for several hours. You will be given a prescription for powerful pain medication when you are discharged from the hospital. If you find you do not tolerate it well, call our office and we will try another one. Many patients find that lying down accentuates their discomfort. You might sleep better in a recliner, or propped up in bed. A pillow placed behind your elbow may also help.
- In the days following your double row arthroscopic surgery, please keep the post-operative dressing clean and dry. Unless it becomes wet or too tight because of swelling, leave the bandages in place for at least 2 days. REMOVE YOUR BANDAGES 2 days after your surgery. Cover your incisions with Band-Aids to keep from snagging the sutures on clothes. You may shower then, but try to keep the incisions dry for the first 10-14 days. Do not wet your incisions directly (bathing or swimming) until at least 2 weeks post-op.
- The sutures are absorbable and do not need to be removed.
- After surgery, we would like to see you back in the office within 10-14 days. If you don’t have your first post-operative visit scheduled, call our office to make one.
- Start your shoulder post-operative rehabilitation/physical therapy right away. Your physical therapy program is key to a successful outcome. It should be started the day after surgery. A separate prescription will outline the protocol. It often helps to call before surgery to make an appointment with your physical therapist.
- Be in the care of a responsible adult.
- Abstain from drinking alcoholic beverages and from smoking.
- You may eat a regular diet, if not nauseated. Drink plenty of non-alcoholic, non-caffeinated fluids.
- Do not make important decisions or sign legal documents.
- Plan to take a few days off work.
Rehabilitation Following Double-Row Rotator Cuff Arthroscopic Surgery
Dr. Millett has specific guidelines for patients who have undergone arthroscopic surgery. These guidelines are broken down into various shoulder rehabilitation phases. Please refer to the Patient Resources section on this website to view a complete and printable version of the rehabilitation program. Depending on the extent of your injury and surgery, the rehab guidelines may vary. These are simply protocols for all patients who have had arthroscopic shoulder surgery.
For detailed information on severe rotator cuff tears, or to determine if you are a candidate for a double-row arthroscopic rotator cuff repair, please contact the office of Dr. Peter Millett.
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Rotator Cuff Repair FAQ
What happens if you don’t fix a torn rotator cuff?
The severity of the rotator cuff tear and the patient’s activity level will help determine the correct course of treatment. If a rotator cuff tear is left untreated, the tear can progress and extend, essentially creating a larger tear over time. Usually when the tear is getting larger, there will be a noticeable increase in pain that will occur. The progression can occur slowly with repetitive use or abruptly if there is a re-injury of the rotator cuff. Once a rotator cuff tear is diagnosed, an increase in pain and decrease in strength should not be ignored as this likely signals that the tear is getting larger.
Can a rotator cuff heal on its own?
Most rotator cuff tears do not and can not heal on their own. Therefore for most active patients, surgical repair is the preferred treatment approach. While some function can be restored without surgery, the best outcomes are typically after surgical repair. In cases in which there is a small rotator cuff tear or in elderly patients where surgery is not an option, patients can use non-operative measures such as rest, ice, anti-inflammatory medication and physical therapy. The goal of non-operative treatment is to relieve pain and resort strength. If patients are active and use the arm for overhead work or sports is desired, then surgery is typically recommended to repair the rotator cuff tear. Active older patients can still do well with surgical repair and, in Dr Millett’s opinion, there is no age limit on treating rotator cuff tears.
How is rotator cuff surgery performed?
Most commonly, rotator cuff repairs are performed by sewing the torn tendon back down to the bone from where it was originally attached. Dr. Millett prefers a technique called a ‘double-row’ fixation technique. It is also called a Speed Bridge repair and Dr. Millett is considered a pioneer and major developer of this technique. Anatomical an biomechanical studies have shown that double-row rotator cuff repair techniques like the Speed Bridge repair provide the best restoration of the anatomy and compression of the torn tendon, with less gapping at the healing site and increased load-to-failure.
This surgical technique for rotator cuff repair is typically performed arthroscopically. Arthroscopic surgery is less invasive than open surgery and helps reduce muscle injury, and decreases the risk of post-operative stiffness and infection. The patient is positioned in the beach chair position. Once the arthroscopic portals are placed, a bursectomy and subacromial decompression (removal of bone spurs) are performed. Any scarring of the torn rotator cuff tendons is released, and the site on the bone from which the tendon tore is prepared to enhance healing. The rotator cuff tear pattern is then identified. Anchors are placed into the bone to hold the torn tendon in place and sutures are passed compressing the tendon back down onto the footprint of the greater tuberosity, effectively anchoring the tendon back onto the bone from where it tore in the first place.
How long does rotator cuff surgery take?
The complexity of the injury determines surgery time. In most cases, a rotator cuff repair takes about 60 to 90 minutes of surgical time to complete. Dr. Millett prefers to keep his patients overnight to insure that they are completely comfortable after the procedure.
How long does it take for the rotator cuff to heal?
Following rotator cuff surgery, the repair usually needs 4-6 weeks to heal. During this time passive motion (someone else moving the arm) will be allowed and active motion (moving the arm by itself) will start between 3 and 6 weeks, depending on the security of the repair and the quality of the tendon tissue. Dr. Millett prefers to start early motion so physical therapy will commence on the day of surgery. A sling will be required for 4-6 weeks after surgery. After 4-6 weeks, patients will begin a program of active motion and strengthening. Full recovery with unrestricted activities and sports is typically 3.5 to 4 months. It is very important for patients to follow an appropriate post-operative rehabilitation program to ensure that they have optimal results.
All exercises and progressions performed will be prescribed by Dr. Millett and will be implemented by a physical therapist. A skilled physical therapist can really make a huge difference in one’s outcome. To follow Dr. Millett’s physical therapy protocol, please visit: Arthroscopic Rotator Cuff Repair Protocol.
Why have second rotator cuff surgery?
Re-tears are very uncommon. In Dr. Millett’s practice the risk of a re-tear after primary roatror cuff repair surgery is less than 5%. Sometimes, however, even when everything has been done correctly, the repaired rotator cuff tendon fails to heal or there is a new trauma that causes the rotator cuff to re-tear. In such instances, Dr. Millett generally recommends a revision shoulder surgery to ensure a full recovery. A second rotator cuff surgery is a more difficult procedure to perform, which is why it is very important to have a skilled orthopedic surgeon perform the revision. During a revision surgery, Dr. Millett identifies the healthy tendon and reattaches to its anatomic attachment site. Results after revision surgery, although not quite as good as primary repairs, are still quite good and are therefore generally considered beneficial and worthwhile.
What about when there is no tendon to repair?
In the rare cases where there is poor tendon quality or absent tendon, patients may need to consider other options. Sometimes Dr. Millett augments the repair with a collagen patch to reinforce the repair. The collagen patch provides additional support for the repair and helps new cells to heal the damaged area of the tendon. In other cases of massive irreparable tears, patients may need a procedure called a superior capsular reconstruction (SCR) to rebuild the absent rotator cuff tissue. The SCR is an innovative new technique that can be done arthroscopically to salvage the shoulder when there is no tendon to repair.
In some other cases of massive irreparable rotator cuff tears, Dr Millett may consider a tendon transfer surgery. This is usually considered a salvage procedure for younger patients with recurrent rotator cuff tears or irreparable tears. Tendon transfers are effective and yield positive results in these complex cases.
During a tendon transfer for rotator cuff repair, another healthy tendon and its muscle are moved from one location to another to substitute for the chronically torn rotator cuff tendons. To be a candidate for a tendon transfer, patients need to be in good physical health, have strong bones and muscles. Patients must also have an understanding and willingness to follow the strict rehabilitation protocol following a tendon transfer.
How easy is it to re-tear your rotator cuff after surgery?
When initial treatment of a rotator cuff tear has been properly performed and patients follow post-operative guidelines, it is difficult to re-tear the rotator cuff. A re-tear can be caused by a new trauma such as a fall, collision, or motor vehicle accident or by non compliance with the prescribed rehabilitation program when one returns to activities too soon. Sometimes, despite a perfect surgical repair, the repaired tendon may fail to heal back to the bone due to poor tendons, smoking, chronic illness or other comorbid conditions.
What are re-tear of rotator cuff after surgery symptoms?
Symptoms of a re-tear after a rotator cuff repair can include pain over the top or side of the shoulder joint, weakness, and limited range of motion. There may be tenderness to palpation. Patients can also have trouble sleeping on the affected shoulder. To be sure if there has been a re-tear of the rotator cuff, it is important to have an orthopedic surgeon give a proper diagnostic evaluation.
How rotator cuff surgery fails?
Rotator cuff surgery can fail for a number of reasons. The initial surgery could have been incorrectly performed causing the rotator cuff tendon to incorrectly heal back to the bone. Patients who do not follow strict post-operative guidelines can hinder the success of a rotator cuff repair. Sometimes comorbid conditions or smoking may affect the ability of the tendons to heal. Traumatic incidents such a sudden fall, or returning to activity too soon can cause an acute re-tear. Chronic overuse of the shoulder can also cause a rotator cuff surgery to fail.
Is there an age limit for rotator cuff repair?
No, there is no age limit. Active seniors do just as well with surgical repair as do younger patients. Dr Millett has studied this, and while some surgeons think that patients over 70 can just live with the tear managing the pain with ice and pills and living with the disability, Dr Millett believes strongly that arthroscopic rotator cuff repair predictably alleviates pain and restores function and in most instances allows patients the ability to return to sports and an active lifestyle, even in patients over age 70.
