When deciding to proceed with rotator cuff surgery after failing non-operative treatment, there are important factors to consider to optimizing healing rates after surgery. Peri-operative nutrition optimization has been shown to correspond with improved outcomes following surgery. The peri-operative period starts two weeks before surgery and continues throughout post-operative recovery. A well-balanced diet consists of lean protein, healthy fats, vegetables, and unprocessed carbohydrates. Vitamin D is important for bone and tendon healing. Sometimes supplementation in the peri-operative period is beneficial to ensure these requirements are being met. Optimized nutrition can help with wound healing, immune function, and muscle preservation. Additionally, a well-balanced diet can help with blood sugar control for patients with Type II Diabetes. A lower A1C is also beneficial for healing and recovery after surgery. Smoking cessation is another important modifiable factor to consider prior to surgery. Smoking can affect the formation of new blood vessels as well as the quality of existing blood supply in the zone of healing. Taking all of these into account when preparing for surgery can help maximize the potential for healing, which leads to a better outcome and return to function.

Historically, rotator cuff tears were repaired surgically by opening the shoulder to visualize the tissue directly in order to place sutures through the tendon and repair the torn tissue to bone. With advances in technology and surgical technique, rotator cuff repair surgery can be performed through minimally invasive incisions, or portals, around the shoulder. By utilizing a small camera known as an arthroscope, the tendon can be visualized and repaired through small portals without having to directly view the tissue. The minimally invasive nature of arthroscopic surgery allows for faster recovery, a more cosmetic appearance with minimal scarring, less risk of infection, joint stiffness, and pain compared to open surgery.

The torn tendon is repaired using very strong sutures that are anchored in the bone. After mobilizing the tissue and preparing the bone for healing, these sutures are passed through the torn tendon and then used to compress the tissue back to the bone interface. Recent research has shown increased rates of healing with augmentation of the repair site, particularly for certain situations. Older patients, larger tears, and patients with diabetes or history of smoking are some situations in which augmentation has shown benefit. Repair augmentation centers around the idea of improving the healing environment, either with added biology or improved strength. This can be performed by placing a patch, typically made of collagen, over the repair site. Some augments may have small fibers woven through them to enhance the strength of the patch. Over time, the augmentation patches will be incorporated into the tendon, adding thickness and hopefully improving the healing potential, which may lead to better outcomes.

Arthroscopic shoulder surgery is an outpatient procedure, with nearly all patients going home the same day once recovered from anesthesia. In addition to being asleep for the surgery, a regional nerve block is performed pre-operatively to help with pain. The nerve block will numb the operative arm and last longer than the surgery itself. It is important to start taking pain medication prior to the block wearing off to ensure continued pain control after the effects of the block.

The operative arm is placed in a sling post-operatively to support the arm and allow for the repair to heal. The sling helps with immobilization to take stress off the surgical site and to help the arm recover from surgery. Most patients can expect to be in a sling for 4-6 weeks after a rotator cuff repair.

Physical therapy is performed after surgery to regain motion and strength in the shoulder. Initially, exercises will focus on regaining passive range of motion. As passive motion is restored, therapy will advance to work on active range of motion and ultimately strengthening. Complete recovery after rotator cuff repair can take 6-9 months, and sometimes even longer, though most patients will typically feel better with daily activities sooner than that.