In the first stage of an arthroscopic rotator cuff repair, the surgeon performs an arthroscopy to confirm the tendons are torn and to ensure repair is possible. The surgeon performs a Subacromial Decompression to remove any bone pressing on the shoulder rotator cuff tendons. This frees the repair from irritation and allows the tendons to heal and recover. The operation is performed as a key-hole technique. Repair of the tendons is performed through 4 to 5 ½cms incisions around the shoulder. The rotator cuff tendons are repaired back to the humerus with several strong stitches held in place by anchors which are screwed into the bone. Arthroscopic repair takes about 2 hours to perform. The patient is given a general anaesthetic. An injection of local anaesthetic is normally given into the lower neck to anaesthetise the arm, which lasts for about 8 hours following the operation. This keeps the patient very comfortable through their early recovery. Two doses of antibiotics are normally given in the hours following the operation.

The main advantages of arthroscopic repair, when compared with open repair, are there is less post-operative pain and there is less damage to the deltoid muscle.

The patient wakes up in a sling in the theatre recovery unit. They are then transferred back to the ward. Most surgery is performed as a day-case stay. The patient cannot start using the arm straight away. The repair must be protected in a sling usually for about 4 weeks. Physiotherapy however is started early with the first sessions given before the patient goes home. Passive range of movement exercises as started as soon as the patient can tolerate it. The physiotherapist lifts the arm to a range of movement advised by the surgeon. This varies between patients. Your physiotherapist will advise you on what you can do and give you a personalised routine of exercises. After 4 weeks active assisted and then full active movements are started. You will normally be off work for between 3 and 4 months. Patients doing heavy manual work may take longer.

The main complications of surgery are infection, re-tearing of the tendons, nerve and vessel injuries, shoulder stiffness and anaesthetic complications.