NYU Langone surgeons offer advanced techniques to repair torn rotator cuffs that do not respond to nonsurgical treatments. These procedures include minimally invasive approaches to repair and reconstruct tissue, as well as open—also known as conventional—surgery to replace the shoulder joint. Our doctors may also discuss with you the use of biologics, medicines made from biological sources such as cells and proteins, to complement surgery.
Our doctors are trained in arthroscopic surgery, or arthroscopy, which is performed through three or four small incisions, rather than one large open incision, allowing for more-rapid healing and recovery. A tiny camera, inserted through one of these incisions, enables doctors to view your shoulder joint and damaged tissue and the surgical repair.
Before your procedure, our anesthesiologists and orthopedic surgeons develop a comprehensive pain management plan to keep you comfortable during and after surgery.
Most of our surgeries are outpatient procedures performed at the NYU Langone Ambulatory Care Center East 38th Street. After surgery, doctors recommend pain management and physical and occupational therapy to manage shoulder pain, restore motion, and ensure proper healing.
NYU Langone orthopedic surgeons are highly trained in the latest approaches to rotator cuff repair, which is often the procedure of choice for people who don’t respond to other medical treatments. The type of repair the surgeon chooses is tailored to each person’s injury, since it takes into account the tear thickness, the tear pattern, and whether the tendon is retracted.
Using arthroscopy, surgeons pass sutures through the torn tendon to connect it back to the area of the humerus, the upper arm bone, where the tissue has become fully or partially detached. Surgical anchors are inserted into the top of the humerus to help secure the tendon to the bone. Suturing and anchors help to compress the tendon to the bone, strengthening the attachment and providing good biomechanical repair. Surgery takes from 45 minutes to several hours.
Your surgeon may recommend superior capsule reconstruction for large rotator cuff tears that cannot be treated with repair surgery. The superior capsule, which is the top portion of strong connective tissue that lines the shoulder joint, helps provide joint stability. People with an irreparable rotator cuff tear also have a damaged superior capsule.
For this outpatient arthroscopic procedure, surgeons remove damaged rotator cuff tissue that cannot be repaired and place an allograft, made of donor tissue, at the socket to replace the superior capsule. The graft is sutured and anchored to the head of the humerus, or ball, and to the glenoid, also called the socket. Nearby remaining healthy tendon tissue is sutured to the graft. The allograft stabilizes the socket, while the remaining muscles around the shoulder help with movement.
Our surgeons may offer this procedure to younger people who are not candidates for shoulder replacement surgery because of the limited lifespan of an artificial joint prosthesis. Allograft reconstruction may also be a possibility for those who have had previous rotator cuff surgery that did not fix the tear. Superior capsule reconstruction surgery typically takes up to 90 minutes.
Our surgeons may offer a tendon or muscle transfer to people who have tears that have been neglected, causing the rotator cuff tendon to deteriorate to the point where repair surgery is not an option. The surgery is designed for younger people with profound shoulder weakness, specifically with rotating their arm out to the side. For this procedure, your surgeon may use a combination of minimally invasive and open techniques to remove a muscle or tendon from your upper back. This tissue is sutured to the humerus and any healthy tendon or muscle tissue to restore rotator cuff movement. This outpatient surgery may take several hours.
In people who have a torn rotator cuff that has led to arthritis or degeneration of the shoulder joint, a surgical procedure called a reverse total joint replacement may be necessary. This procedure, performed with general anesthesia, may be an option for people who have tears that have affected the shoulder over a long period of time. People who have symptoms such as severe weakness of the arm and chronic pain may also benefit from this surgery.
During this procedure, surgeons replace damaged areas of the shoulder joint with durable prosthetic, or artificial, parts. This is an open surgical procedure, meaning that surgeons access the joint through a single incision made above the shoulder joint.
A reverse total shoulder replacement restores function in the shoulder by reversing the natural anatomy of the joint. Instead of replacing the shoulder’s ball-and-socket components with matching prosthetic parts, surgeons switch their positions and implant a metal ball in the shoulder blade and a plastic socket into the top part of the humerus.
The procedure takes several hours. Afterward, the new shoulder joint no longer uses muscles in the rotator cuff and instead relies on the outer arm muscle, the deltoid, to function. This helps to improve range of motion.
After surgery, you spend a night or two in the hospital, where pain management specialists are available to ensure that you have the pain relief medication you need to recover comfortably. A physical therapist who specializes in recovery from joint replacement surgery visits you the day after surgery to help you gently start to use your shoulder and to show you exercises to do at home.
A newer surgical option uses a biodegradable balloon, called InSpace. The balloon implant, which is placed on the head of the humerus through a simple arthroscopic procedure that takes 30 to 45 minutes, allows rehabilitation to start immediately. The balloon mimics the function of an intact rotator cuff, allowing muscles to reengage. As the balloon degrades, muscles of the shoulder, reeducated through physical or occupational therapy, start to take over, improving your shoulder function and reducing pain. Your physician determines if you are a good candidate for the balloon procedure.
Our surgeons sometimes use biologics to complement surgery. For example, during surgery for a rotator cuff tear, your doctor may place a collagen-based patch on the site of injury to help with healing, especially if the tendons are deteriorating. Collagen is a protein that is makes up tendons, ligaments, and muscles. These patches are thought to work at the cellular level to help with repair, but they do not replace damaged tissue.
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