How can a torn rotator cuff be fixed as effectively with an arthroscopic technique as compared to using an open technique?

I saw a young patient this week with an acute large rotator cuff tear, and this was indeed the question that he raised. First--it's a good question. One might intuitively think that "more is better". So---would'nt it stand to reason that seeing the entire shoulder "opened up via a traditional incision" is better.

Interestingly---the visualization afforded with the arthroscope is better and provides a number of different vantage points. When the cuff tendon is retracted, the acromion bone prevents visualization, whereas the scope allows visualization.

Now, that having been said, to execute a successful arthroscopic repair requires a fair amount of skill and experience, and absent that, it may be better to have your repair the old fashioned way------even if it means alot more postoperative pain and potentially increased morbidity due to the larger incisions etc.

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