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What Is Rotator Cuff Repair Surgery?
The rotator cuff is a complex network of four muscles and their tendons—supraspinatus, infraspinatus, teres minor, and subscapularis—that envelop the head of the humerus (upper arm bone) like a cuff, providing dynamic stability to the glenohumeral joint while enabling a wide range of shoulder motions, including abduction, internal/external rotation, and overhead lifting. This structure works in concert with the deltoid muscle and scapular stabilizers to maintain humeral head centering during arm elevation, preventing impingement against the acromion (the bony arch of the shoulder blade).
Pathoanatomy of rotator cuff tears involves degeneration or trauma leading to partial-thickness or full-thickness disruptions in the tendon fibers. Degenerative tears, common in individuals over 40, result from chronic microtrauma, reduced vascularity in the “critical zone” of the supraspinatus tendon (about 1 cm from its insertion), and age-related collagen weakening, often exacerbated by subacromial impingement where the tendon rubs against the acromion or coracoacromial ligament. Acute tears may occur from falls, heavy lifting, or sports involving overhead activities like swimming, tennis, or baseball. Symptoms include night pain that worsens with overhead reaching, weakness in arm elevation or rotation, limited active range of motion (especially abduction and external rotation), and a positive impingement sign during clinical tests. If left untreated, tears can progress in size, leading to fatty infiltration of the muscles (Goutallier stages), retraction of tendon edges, superior humeral head migration, and eventual cuff tear arthropathy—a form of shoulder arthritis with joint degeneration and pseudoparalysis.
At OV Surgical, we specialize in rotator cuff surgery for Canadians with advanced arthroscopic techniques that minimize downtime and maximize results. Through multiple tiny incisions (less than 1 cm), our surgeons insert an arthroscope—a small camera—to visualize the tear and surrounding structures in real-time, including the subacromial space, biceps tendon, and labrum. For full-thickness tears, we perform a subacromial decompression (acromioplasty) to shave down bone spurs or reshape the acromion, creating space to reduce impingement. The torn tendon is mobilized, and its edges are debrided to healthy tissue. Using suture anchors—small bioabsorbable implants inserted into the humeral head—we pass strong sutures through the tendon and reattach it anatomically to its footprint on the greater tuberosity, often in a double-row configuration for enhanced biomechanical strength and footprint compression. In cases of partial-thickness tears (e.g., articular-sided or bursal-sided), we may opt for debridement and transtendon repair if over 50% thickness is involved. For massive or irreparable tears, advanced options like biological augmentation (e.g. Regeneten patch from Smith and Nephew, CuffMend from Arthrex) or tendon transfers may be considered to restore function. The procedure typically lasts 1-2 hours, with meticulous attention to preserving function. The procedure typically lasts 1-2 hours, with meticulous attention to preserving
Recovery
Post-procedure, our evidence-based protocols integrate cryotherapy, neuromuscular electrical stimulation (NMES), and progressive physiotherapy to accelerate healing and restore function, tailored to tear size (small/medium vs. large/massive) and tissue quality. In the immediate protection phase (0-6 weeks), patients wear an abduction sling to immobilize the shoulder, limiting stress on the repair while allowing passive range of motion (PROM) exercises under therapist guidance to prevent adhesions—starting with pendulum swings, forward flexion to 90-120 degrees, and external rotation to 30 degrees. Pain management includes ice and anti-inflammatories to control swelling.
From weeks 6-12 (active-assisted phase), the sling is weaned off, and active-assisted range of motion (AAROM) begins with pulleys or wands, progressing to full passive ROM while avoiding aggressive stretching to protect tendon healing. Submaximal isometrics while avoiding aggressive stretching to protect tendon healing. Submaximal isometrics for the rotator cuff and scapular stabilizers are introduced to rebuild neuromuscular control. By weeks 12-16 (active strengthening phase), full active ROM is targeted, with resistance exercises like elastic bands for internal/external rotation, scapular retraction, and low-weight overhead presses, emphasizing eccentric control to mimic daily activities. Advanced phases (16+ weeks) incorporate plyometrics, sport-specific drills (e.g., throwing progressions for athletes), and functional testing. Most patients achieve full motion by 12 weeks and strength milestones by 4-6 months, with clearance for overhead work or sports in 6-12 months, verified through tests like shoulder strength assessments (>90% symmetry), drop-arm tests, and lift-off evaluations. We emphasize psychological readiness, addressing fear of re-injury through gradual exposure.
Benefits
With success rates of 90-95% for small to medium tears (70-85% for large/massive), private rotator cuff repair at OV Surgical restores shoulder stability, prevents re-injury, and allows you to get back to sports and/or other aspects of life that are important to you. Our patients report enhanced shoulder function, confidence, and quality of life, backed by meticulous follow-up and data-driven protocols.
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