Arthroscopic rotator cuff repair · Dr Joe Coory

Type: Keyhole (arthroscopic) tendon repair
Anaesthesia: General + interscalene block
Hospital stay: 1 night
Sling: 4–6 weeks
Return to driving: 6 weeks
Final outcome: 9–12 months

What the operation is.

An arthroscopic rotator cuff repair is a keyhole operation in which the torn cuff tendon is re-attached to its bony footprint on the greater tuberosity of the humerus. The procedure has evolved considerably over the past two decades - modern repairs are double-row or suture-bridge constructs that restore the tendon footprint more anatomically than older single-row repairs.

How it is performed.

Anaesthesia

The operation is performed under general anaesthesia. An interscalene regional block, placed by the anaesthetist before surgery, provides 12–18 hours of excellent post-operative pain relief.

Positioning and approach

The patient is positioned in either beach-chair or lateral decubitus position. Three to five 5 mm portals are made around the shoulder.

The repair

An arthroscope (4 mm camera) is introduced through a posterior portal. The joint is inspected for any associated pathology - labral, biceps, or articular cartilage - which is addressed as required. The arthroscope is then moved to the subacromial space. The torn cuff tendon is identified, gently mobilised back to its native footprint, and the bone is prepared. Suture anchors are placed in the greater tuberosity and the tendon is sewn down using a double-row or suture-bridge construct.

Bio-augmentation

In selected cases - re-tears, chronic tears, older patients, smokers and diabetics - Dr Coory may augment the repair with a bio-inductive collagen patch placed over the tendon repair. The decision is individualised and discussed at consultation.

Recovery timeline.

Week 0–1

Sling worn continuously, including overnight.
Regional block lasts 12–18 hours.
Hand, wrist and elbow exercises commenced.

Week 1–6

Sling continues.
Passive range of motion under your physiotherapist.
No driving. Light desk work usually possible from week 2–3.

Week 6–12

Sling discontinued. Active-assisted progressing to active range of motion.
Driving resumed. Light manual work resumed.

Month 3–6

Strengthening commences with the posterior cuff and scapular stabilisers first.
Return to most manual work and recreational activity.

Month 6–12

Return to overhead sport and heavy lifting.
Strength continues to improve out to a year.

What the evidence says about healing.

Tendon healing after arthroscopic cuff repair depends most strongly on tear size, tendon quality, age, smoking and diabetic status. In small to medium tears with healthy tendon tissue, healing rates exceed 85%. In larger or chronic tears, healing rates are lower (50–70%). Importantly, even tears that do not fully heal often produce a satisfactory clinical outcome.¹

Rehabilitation protocol.

A written copy of this protocol is provided to your physiotherapist on the day of surgery. The timeline below is a guide - progression is based on clinical milestones, not the calendar alone.

Phase 1 - weeks 0–6 (protection)

Sling at all times except during prescribed exercises.
Passive forward flexion to 90 degrees (increase to full by week 6).
Pendular (Codman’s) exercises.
Scapula setting and posture correction.
Active range of motion for elbow, wrist and hand.
No active shoulder movement. No combined abduction, external rotation and hand-behind-back positions.

Phase 2 - weeks 7–12 (active movement)

Wean sling.
Active-assisted forward flexion progressing to active.
External rotation in adduction to 70 degrees.
Gentle isometric infraspinatus from week 10.
Internal rotation in 90 degrees of abduction from week 10.
Active hand behind back as tolerated.

Phase 3 - week 12 onwards (strengthening)

Gentle rotator cuff resistance work.
Progressive increase in cuff and scapula stabiliser workload.
Proprioceptive and functional rehabilitation.
Return to sport guided by strength, control and surgeon review.

Accelerated protocol (selected patients)

For smaller tears with good tissue quality, an accelerated pathway may be used at the surgeon’s discretion:

Sling for 3–4 weeks only.
Active-assisted range of motion from week 0–4.
Submaximal isometrics from week 4–6.
Open-chain rotator cuff strengthening from week 6–12.
Return to contact sport from week 12 onwards.
Avoid combined abduction, external rotation and hand behind back in the early phase.

View the recovery roadmap for the full five-phase journey, or visit For Physiotherapists to request protocols directly.

Frequently asked questions.

Will my cuff definitely heal?

Healing depends on tear size, tendon quality, age, smoking and diabetic status. In small to medium tears with healthy tissue, healing exceeds 85%. In larger or chronic tears, it can be 50–70%. Importantly, many cuffs that do not fully heal still produce a satisfied patient because the symptoms improve.

How painful is the recovery?

The first 48 hours are managed by the interscalene block. Pain peaks around days 3–5, then settles steadily. Most patients are off strong analgesia within 1–2 weeks.

How long am I in the sling?

4–6 weeks, depending on tear size. Smaller tears typically 4 weeks; medium to large tears 6 weeks.

When can I drive?

Six weeks. You need to be sling-free, off opioid medication, and able to perform an emergency stop comfortably.

Can I sleep in bed normally?

Most patients find sleeping in a recliner or propped up with pillows is more comfortable for the first 2–4 weeks. Side-sleeping on the operated shoulder is avoided until cleared by your surgeon and physiotherapist.

When can I return to manual work?

Light manual work at 4–6 weeks. Heavier manual work at 4–6 months. Heavy overhead work, last.

References.

Galatz LM, et al. The outcome and repair integrity of completely arthroscopically repaired large and massive rotator cuff tears. J Bone Joint Surg Am. 2004;86(2):219–224.
Boileau P, et al. Arthroscopic repair of full-thickness tears of the supraspinatus: does the tendon really heal? J Bone Joint Surg Am. 2005;87(6):1229–1240.
Bishop J, et al. Cuff integrity after arthroscopic versus open rotator cuff repair. J Shoulder Elbow Surg. 2006;15(3):290–299.

Arthroscopic rotator cuff repair.