The rotator cuff includes four muscles - the supraspinatus, the infraspinatus, the subscapularis, and the teres minor. These muscles cover the humeral head and are largely responsible raising the arm overhead, and rotating the arm side to side. Acute trauma and gradual attenuation are the two most common ways that cuff tears develop.

When cuff tears exist but are not painful, there still exists a 50% chance that they will become symptomatic within 3 years. The problem that exists is that if a tear gradually becomes larger over time, or if it retracts--repair may not be possible down the road. Thus, in patient swho are active, full thickness tears are often best treated with repair. Further, research has recently shown that after 2 or so years, irreversible atrophy and fatty infiltration occurs. In addition to potentially preventing repair, these changes may compromise healing rates and  the outcome following subsequent repair, if possible. However, when a tear is not causing pain or dysfucntion, nonoperative treatment may be an option. see this link for more info:

http://www.rearmyourself.com/article/The%20Asymptomatic-Rotator%20Cuff%20Tear-Should%20this%20be%20repaired

Though open incisions, and mini incisions are popular ways to achieve repair--arthroscopic techniques allow repair with much less pain postoperatively--largely because the work is performed through 3-4 1 cm incisions, only.

Since 2005, I have had the privilege of repairing approximately 100 rotator cuff tears per year.  These have all been sucessfully performed arthroscopically, and  my patients' outcomes have reflected what has been reported in the literature--when tears are less than 2-3 cm, 90% of patients have great outcomes; when larger than 3 cm—large tears---it drops to between  50 and 85%.

Satisfactory outcome revolves around the status of the cuff muscle (is there atrophy or fatty infiltration?), surgical skill, compliance with postoperative therapy, and appropriate decision to proceed to surgery in the first place. Tension- free repair is critical.

 The newest technique utilizes a "double row repair", which maximizes restoration of the native "footprint" via a "transosseous equivalent" technique. I have attached a recent JSES article showing 83% success rates--a percentage heretofore reported with 1 tendon tear repair only. The videos below show a 1 tendon tear (supraspinatus) and a 2 tendon repair (supra- and infraspinatus).

Despite the fact that arthroscopic repair allows full repair with 1 cm incisions, the biology of healing has not changed—patients must be willing to remain in a sling for 6 weeks before beginning an active range of motion program. Active motion starts at 6 weeks, strenghtening at 12 weeks, and full recovery may take between 6-12 months depending on the size of the tear and the quality of the tissue.

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