Why this operation has been suggested¶
Dr Kieran Hirpara, an upper-limb surgeon at Mater Private Hospital Rockhampton, starts with the least invasive options that suit your condition. Patients are generally referred to our clinic by their GP; if a physiotherapist has suggested you see us, you will still need a referral from your GP in order to be eligible for the Medicare rebate. A clinic assessment establishes the diagnosis. For degenerative or long-standing problems we usually try non-operative care — activity change, physiotherapy or hand therapy, splinting, and injections — and consider surgery when that has not given enough improvement.
This operation repairs a torn shoulder tendon that has failed to heal after a previous attempt. It is typically offered when persistent pain and stiffness remain despite conservative treatment. We aim to reduce your pain and improve your shoulder function. Evidence shows significant improvement in pain and function at five years, though results are generally less robust than for a first-time repair. We use this procedure to help you regain stability and daily movement when other options have not provided sufficient relief.
Before the operation¶
Please fast for seven hours before your surgery. We ask this so we can bring you forward if the list runs early. Arrange for someone to drive you home and stay with you. Wear comfortable clothing and bring a list of your current medications. We use an arthroscopic approach, placing small incisions around the shoulder, including at the back, to view the joint with a camera. Your surgeon will review X-rays or MRIs to plan your repair. Blood tests and an anaesthetic review are not routine. If you have other medical conditions, you may need blood tests or a review with the anaesthetist.
On the day¶
You present to the hospital’s surgical admissions unit, where you are checked in and prepared for theatre. You meet the anaesthetist, who talks you through the plan. This operation is done under general anaesthetic combined with a regional nerve block. You will be fully asleep for the operation, and the block — an injection that numbs the nerves supplying the arm before you wake up — provides pain relief for the first 12 to 24 hours after surgery. The anaesthetist will meet you before the operation and talk you through both parts.
You are then taken into the operating theatre, where the operation is performed. You wake up in the recovery area, where nurses monitor you while the anaesthetic wears off. Once you are stable, you either go to the ward or go home, depending on the procedure and your recovery.
What the operation involves¶
We perform this surgery using keyhole techniques. This means we make several small cuts around your shoulder. At least one cut is at the back of your shoulder. We insert a tiny camera and special tools through these openings. This lets us see inside the joint without making one large cut.
Your surgeon will first clean up the area. This often involves removing any inflamed tissue that might be causing pain. We may also perform a subacromial decompression. This creates more space for your shoulder to move smoothly.
Next, we repair the torn tendon. We usually use a double-row method. This involves placing small anchors into the bone. We pass strong sutures through the tendon and secure them to the bone. This holds the tendon firmly in place so it can heal. Depending on what we find during surgery, we might use a single-row repair or different types of anchors.
We often place a biological scaffold under the tendon at the repair site. This material helps encourage the tendon to heal back onto the bone. You can read more about this at EnFix biological scaffold.
Once the repair is secure, we close the small cuts with stitches. We do not use staples or skin glue for these incisions. A dressing is applied to protect the area while you begin your recovery.
After the operation¶
You will wake in the recovery ward with pain managed safely. Your arm rests in a simple sling for comfort, which you remove only for exercises and washing. Most patients stay one night in hospital after this operation, though some are able to go home the same day. Please ensure someone stays with you for the first 24 hours to help you. We will guide you on wound care and gentle movement. You must not drive while wearing the sling. Our policy is that you cannot drive for at least six weeks after any shoulder operation, regardless of which arm was treated. You may drive again once your surgeon clears you, typically at the six-week review. For full details, see Driving after upper-limb surgery.
Recovery¶
You can expect some pain and swelling in the days and weeks after your surgery. This is normal. Your shoulder will feel stiff and sore as it heals. We manage this discomfort with medication and ice. The swelling will settle gradually, making the area feel more comfortable.
You will wear a simple sling for comfort. You can take it off for exercises and washing. Your physiotherapist will guide you through gentle movements to restore mobility. We focus on safe, gradual progress. Avoid heavy lifting or reaching overhead until your surgeon clears you. Sleep may be difficult at first; propping yourself up with pillows often helps.
Your timeline may differ from others. Recovery varies between individuals. Your surgeon and physiotherapist will guide you based on your healing. You will know when to progress by how your shoulder feels, not just by the calendar. For example, you can drive once your surgeon clears you, typically at the six-week review. Please see our guide on Driving after upper-limb surgery for more details.
Revision rotator cuff repair provides significant improvement in pain and function at 5 years postoperation. Clinical results show improvements in scores and decreased pain, especially with a new repair. Double-row arthroscopic repair with dermal allograft augmentation leads to improved functional outcomes. Interpositional bridging grafting also leads to significant improvement in functional outcome, though it is associated with a high retear rate. Successful outcomes are observed at long-term follow-up with and without bioaugmentation. There are no differences in repair integrity or clinical outcomes between workers' compensation patients who underwent revision arthroscopic rotator cuff repair with an onlay bioinductive implant compared to those who underwent standard revision rotator cuff repair.
Optimization of surgical techniques and the use of appropriate biologic or tendon transfer techniques, if indicated, is the best method for the management of failed rotator cuff repair in young patients. Latissimus transfer, as a salvage procedure for failed rotator cuff repair with loss of elevation, allows for significant return of active elevation and function with minimal post-operative pain. Concurrent subacromial decompression confers a 26% relative risk reduction (NNT≈4 patients) for revision rotator cuff repair when compared to arthroscopic rotator cuff repair alone in patients with partial or complete rotator cuff tears. Patients who received a corticosteroid injection within 6 months prior to rotator cuff repair were much more likely to undergo a subsequent reoperation within the following 3 years.
What can go wrong¶
Most patients do well, but problems can occasionally happen. Your surgeon and the team monitor you closely to spot any issue early.
Having a single injection in your shoulder within the year before your revision rotator cuff repair does not increase your risk of needing further surgery. This is a common concern, but the evidence shows it is generally safe.
However, if you have had two or more injections in the same shoulder within that same year, your risk of needing another revision surgery later is substantially higher. You should discuss this history openly with your team so they can plan your care carefully.
If you received an injection within six months prior to your revision rotator cuff repair, you are much more likely to undergo revision within the following three years. This timeline is important for your long-term planning and understanding of your recovery trajectory.
There is no clear evidence that platelet-rich plasma (PRP) injections affect the likelihood of needing revision surgery after a primary rotator cuff repair. PRP involves using your own blood components to promote healing, but it does not appear to change the need for future operations in this context.
If you notice new or worsening pain, swelling, or changes in shoulder function at any point, contact our clinic promptly. Early attention helps manage any potential issues effectively.
The complications table on this page lists typical rates if you want the specifics.
When to call us¶
Call us if you have a fever, increasing wound redness or discharge, or sudden severe pain. Go to emergency if you notice calf swelling, shortness of breath, loss of sensation, or cannot move your limb. These signs need urgent assessment. We want to ensure your recovery stays on track. Please contact our clinic immediately if any of these symptoms occur.
Where to read more¶
This page is about the operation itself. The condition it treats — including what the evidence shows about when surgery helps and when it does not — is covered in more detail on the Rotator Cuff Disorders page.
Where to read more about the condition¶
This page is about the operation itself. The condition it treats — including what the evidence shows about when surgery helps and when it does not — is covered in more detail on the Rotator Cuff Disorders page.