Arthroscopic rotator cuff repair in live surgery
Live rotator cuff tear surgery with biceps tenodesis, double-row tendon reattachment, and acromioplasty. Dr. Steve Brenn discusses each technical step, operative decisions, and criteria for repair and rehabilitation.
Doctors
Topics
Treatments
Advice
- Dr. Steve Brenn
- Case presentation
- MRI imaging
- Surgical gesture
- Suture techniques
- Thenodesis
- Arthroscopic repair
- Thenodesis
- Acromioplasty
- Double row
- Post-operative rehabilitation
- relative urgency of the traumatic cuff
- double row
- avoid pre-op infiltration
- biceps management
Arthroscopic rotator cuff repair: objectives and procedure
Arthroscopic repair aims to reapply the ruptured tendon to its bony footprint, treat associated injuries, and restore function. In the procedure presented, a full-thickness supraspinatus tear is repaired with a double-row strategy, after a complete intra-articular assessment. The long biceps is subject to a dedicated procedure (tenodesis or tenotomy) to stabilize the rotator interval and reduce pain. Acromioplasty is considered in a reasoned manner, based on objective criteria and planning. Finally, postoperative rehabilitation is integrated from the planning stage to ensure healing and a return to daily activities.
Intra-articular time: biceps, subscapularis and lesion mapping
The initial exploration specifies the condition of the cartilage, the long biceps and the subscapularis. A medial subluxation of the biceps can maintain a high lesion of the subscapularis; a procedure on the biceps then becomes judicious. Intra-articular tenodesis anchors the tendon to the bone, while tenotomy releases the tendon; the choice depends on the patient profile and the surgeon's preferences, with comparable functional results in many cases. This step then guides the repair of the cuff itself and prepares the next steps (suture management, anchoring strategy).
The surgeon almost always has to make a move on the long biceps during the rotator cuff repair.
Repair without overstretching: technical principles
Double-row repair distributes stress and improves footprint coverage. The sutures passed through the tendon are secured to a second lateral anchor after checking the reduction. It is essential to avoid over-tensioning, which would compromise healing; the objective is an anatomical, stable, and vascularized alignment. Each step (thread passage, tension adjustment, and anchor screwing) is checked visually and manually to ensure tendon adhesion to the bone.
Acromioplasty and “critical shoulder angle”: a targeted practice
Acromioplasty is no longer a systematic procedure. Recent data favor an indication guided by shoulder morphology and kinematics, particularly the "critical shoulder angle" (lateral overhang of the acromion). Individualized planning allows for the identification of areas of conflict to be resected, with documented functional gains in some patients. Conversely, wide and routine resection of the coracoacromial ligament is not supported; this structure could contribute to a functional "arch," hence the caution required. Finally, acromioclavicular pathology is treated only if it is symptomatic.
Post-operative stiffness is often a sign that the rotator cuff is healing well.
Post-operative care and rehabilitation
The follow-up treatment combines initial protection, pain management, and progressive mobilization. Early stiffness, when controlled, can accompany tendon healing and should be interpreted with caution. The progression of the protocol depends on pain, initial flexibility, and the strength of the repair. Coordinated work with the physiotherapist optimizes the return to personal and professional activities.
Key points for the patient
After a traumatic rupture, particularly in young and active individuals, repair is discussed without delay to optimize the chances of healing. A procedure on the long biceps is frequently associated and contributes to relief. Acromioplasty is decided on a case-by-case basis; it is neither systematic nor uniform. Finally, success depends as much on the technique as on rehabilitation and adherence to the protocol. Preoperative infiltrations should be avoided when surgery is planned in the short term.
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