Can A Full Tear Be Repaired Arthroscopically, or Is Open Surgery Needed?

Yes, a full tear can be repaired arthroscopically, and open surgery is not always needed. Many full-thickness tears can be successfully treated with arthroscopic techniques using small incisions and specialized instruments. However, you may need open surgery if the tear is very large, complex, and involves significant tissue damage.

At Total Orthopedics & Sports Medicine, our surgeons perform a detailed physical examination to assess your rotator cuff tendon, shoulder joint, and rotator cuff muscle. After this assessment, we review your test results and imaging to determine whether arthroscopic rotator cuff repair or open surgery is the most effective option for your torn rotator cuff. Call 855-321-6784 to schedule your consultation.

How Do Doctors at Total Orthopedics & Sports Medicine Choose Between Arthroscopic vs Open Surgery?

To determine the best surgical treatment for a torn rotator cuff, our doctors at Total Orthopedics & Sports Medicine conduct specific physical tests. These tests include the Empty Can Test, Jobe’s Test, External Rotation Lag Sign, and the Drop Arm Test. Here’s how these physical exams help our surgeons identify the extent of your injury:

• Empty Can Test: Examines the strength of the supraspinatus tendon and detects partial or full-thickness tears.
• Jobe’s Test: Assesses the supraspinatus tendon and detects partial tears. According to NCBI, Jobe’s test has a sensitivity of 88%.
• External Rotation Lag Sign: Measures infraspinatus and teres minor strength to detect tendon tears and shoulder dysfunction.
• Drop Arm Test: Detects full-thickness rotator cuff tears and loss of arm control. According to Physiopedia, the drop arm test has a sensitivity of 73%.

After the physical examination, our doctors review your X-rays to analyze the humeral head, scapula, and bony structures surrounding the shoulder joint. We also use MRI or ultrasound to examine the tendon tissue and shoulder muscles. This detailed assessment helps our surgeons decide whether arthroscopic repair or open surgery is the most effective approach for restoring your shoulder function.

Which Tendons Are Commonly Affected in Full-Thickness Rotator Cuff Tears??

In full-thickness rotator cuff tears, the supraspinatus tendon is the most frequently affected. According to the NIH, supraspinatus tears occur in 61.9% of men and 38.1% of women. In large or massive tears, the infraspinatus tendon is also affected. Moreover, according to SpringerLink, subscapularis tendon tears occur in 31.4% of patients undergoing rotator cuff repair. While the teres minor tendon is less frequently affected, it can also contribute to external rotation weakness when involved. Here’s how tears in these tendons can affect different shoulder structures:

• Supraspinatus: Reduces your ability to lift the arm sideways and can cause sharp shoulder and arm pain.
• Infraspinatus: Weaken external rotation of the shoulder, making it difficult to move your arm backward or rotate it outward.
• Subscapularis: Affects internal rotation and destabilizes the humeral head, making activities like reaching behind your back or performing rotational movements painful.
• Teres minor: Decreases external rotation strength, reduces overall arm control, and can limit upper arm bone function during sports.

How Do Surgeons Assess Tendon Health During Arthroscopic Surgery?

During arthroscopic rotator cuff surgery, shoulder surgeons assess tendon health by examining the tendon’s thickness using a high-definition camera. This camera provides a clear, magnified view of the shoulder joint, allowing surgeons to identify fraying, thinning, or degenerative changes in the torn tendon. After that, they use miniature surgical instruments (called a probe) to gently touch and test the tendon. This process helps them check tendon strength, mobility, and elasticity.

Which Factors Can Affect the Success of Arthroscopic Repair?

The success of arthroscopic rotator cuff repair depends on tear size, tendon quality, and muscle condition. For instance, full-thickness tears larger than 3 cm, degenerated tendon tissue, and fatty infiltration of the rotator cuff muscles reduce repair success. Similarly, chronic diseases like diabetes, obesity, or autoimmune disorders can slow healing after arthroscopic procedures.

Additionally, the following factors can also affect the success rate of arthroscopic surgery:

• Tendon retraction: Tendons that have pulled more than 3 cm from the humeral head are difficult to reattach and may require advanced surgical techniques.
• Patient age: Patients over 60 often have slower tendon healing and reduced tissue elasticity.
• Smoking: Nicotine reduces blood flow to the tendon, slowing healing and increasing the risk of repair failure.
• Post-surgery care: Failure to follow movement restrictions or rehabilitation protocols can impact the outcome of surgical repair.

Is Open Surgery Riskier Than Arthroscopic Repair?

Yes, open rotator cuff surgery generally has higher risks compared to arthroscopic repair. Since open surgery involves a larger incision and more tissue disruption, you may experience increased blood loss, longer recovery time, and a higher risk of infection. There’s also a higher chance of nerve injury to the surrounding shoulder structures, including the deltoid muscle.

In contrast, arthroscopic repair uses small incisions, which reduce tissue trauma, minimize shoulder pain, and lower surgical complications. However, in some cases, it may lead to compartment syndrome when irrigation fluid leaks into surrounding tissues, causing excessive pressure on the shoulder muscles. This condition can cause intense pain, swelling, numbness, and limited movement.

How Do Surgeons Visualize and Mobilize the Tendon During Open Surgery?

During open rotator cuff surgery, surgeons make a 5–8 cm incision over the shoulder to directly access the shoulder joint and surrounding structures. Direct visualization helps surgeons assess tear size, bone spurs, tendon quality, and the exact location of retraction. After the incision, surgeons carefully release scar tissue and adhesions that restrict movement.

They may also use retractors, elevators, and tendon hooks to gently mobilize the tendon. This process ensures the tendon can be reattached securely to the humeral head, which restores shoulder function and range of motion. Moreover, in cases of severe pain and retraction, surgeons may perform the following tendon mobilization techniques to restore proper attachment:

• Tendon release: Carefully separating the tendon from surrounding adhesions and scar tissue to allow proper positioning.

• Margin convergence: Suturing the edges of a torn rotator cuff to reduce gap size before reattachment.
• Tendon advancement: Gently stretching or moving the tendon closer to its original insertion site.
• Tendon transfer: Using a healthy tendon to restore joint function if the injured tendon cannot reach the humeral head.

Then, our surgeons use suture anchors to secure the tendon and reduce the risk of re-tears or further injury. We also check tendon mobility and tension throughout the procedure to ensure proper placement and support a safe, effective recovery. Call us today at 855-321-6784 to book your consultation.

Do Surgeons Convert Arthroscopic Surgery to Open Repair if Needed?

Yes, surgeons sometimes convert arthroscopic rotator cuff surgery to open repair if the tendon tear is large, complex, or involves significant tissue damage. During the procedure, surgeons assess the tendons’ mobility and the quality of the tissue. If they cannot achieve secure reattachment arthroscopically, they may make a larger incision to perform an open repair safely.

How Does Recovery Time Compare in Arthroscopic vs Open Surgery?

Recovery from shoulder arthroscopy is faster than open surgery, and most patients resume light activities within 2-4 weeks, while complete recovery usually takes 3-6 months. In contrast, open surgery often requires up to 12 months for complete healing, which significantly extends the overall rotator cuff injury recovery time.

Tip:Avoid lifting, pushing, or sudden shoulder movements during the first 6–8 weeks to protect tendon healing.

Let Total Orthopedics & Sports Medicine Help You Decide the Best Repair Method for a Full-Thickness Tear — Visit Us Now!

A rotator cuff tear can limit your shoulder movement and daily activities. You may struggle with persistent pain, weakness, or stiffness, especially during overhead motions. Additionally, you may feel stressed and confused about which surgical treatment is best for your shoulder pain.

With 21 years of experience, our team at Total Orthopedics and Sports Medicine carefully assesses your medical history, symptoms, and activity level to determine the most suitable surgical technique for your shoulder condition. We also use imaging tests such as X-rays or magnetic resonance imaging to confirm the severity of the shoulder injury. Call us at 855-321-6784 or visit 16 East 29th Street, Bayonne, NJ 07002 for immediate pain relief.

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