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Ask the Sports Doc: Smaller surgery

Question from a patient: I have been diagnosed with a rotator cuff tear of the shoulder. I am starting to get progressive weakness when I lift my arm. Physical therapy has not helped and I was wondering what are the benefits of having my rotator cuff being repaired arthroscopically versus having an open repair.

Dr. Patel: Arthroscopic surgery has made great strides in the past 10 years. There are so many innovative tools allowing the surgery to be performed more efficiently than ever before. During my fellowship, I was fortunate to learn techniques in arthroscopic surgery that enable me to never make a large incision to repair the rotator cuff.

Arthroscopic surgery involves making small incisions called portals. These portals are the size of a pencil eraser. The camera and other arthroscopic instruments are placed through the portals for the surgery. Arthroscopy also involves using saline solution that helps keep the operative field clear and help to remove any debris during the surgery.

Arthroscopic rotator cuff surgery has several benefits when compared to a traditional open rotator cuff repair. There is a lot less bleeding because a large incision has not been made. Cosmetically, the portals are more appealing as well.

I also believe the surgery can be performed easier arthroscopic because the operative field is magnified on a monitor which allows the surgeon to see subtle changes in the shoulder.

The surgery also takes less than an hour for most rotator cuff tears. I also like to use a block instead of general anesthesia; by doing that my patients don’t need to go to sleep all the way or have a tube down the throat, instead they take a light nap only.

Finally, I am a big proponent on starting physical therapy early after the surgery, with small portals I don’t have to worry about the incision opening up. Overall, I strongly believe all rotator cuffs can be done arthroscopically if the quality of the tissue is good. If the quality of the soft tissues is not resilient, then an open rotator cuff surgery will not make any difference.