Revision rotator cuff repair Info Consent
Reviewed by Dr Kieran Hirpara, Specialist Orthopaedic Surgeon Last reviewed
Why this operation has been suggested
This page reflects how Dr Kieran Hirpara, an upper-limb surgeon at Mater Private Hospital Rockhampton, approaches this in our clinic. You reach our clinic by GP or physiotherapist referral. We use a clinic assessment to establish the diagnosis. For long-standing problems, we usually try non-operative care first. We consider surgery when that has not given enough improvement.
Your surgeon may have recommended revision rotator cuff repair because you still have pain and limited movement despite prior treatment. This procedure is a second surgery to fix a torn shoulder tendon that did not heal properly after an earlier operation. We perform this as an arthroscopic (keyhole) approach with two or three small incisions and a small camera inside the joint. The main goal is to reduce your pain and improve your shoulder function. While outcomes are not as good as primary repair, significant improvement in pain and function is possible at 5 years postoperation.
Before the operation
We ask you to fast for six hours before your surgery. Please stop taking blood-thinning medicines as your surgeon will advise. Arrange a lift home and bring a list of all current medications. You will need an anaesthetic review and likely X-rays or an MRI scan to check your shoulder’s condition. These tests help us plan your arthroscopic repair, which uses two or three small incisions and a tiny camera. Wear comfortable, loose clothing to your appointment. This preparation ensures we can safely address your persistent pain and improve your shoulder function.
On the day
You will arrive at the hospital and be admitted to the ward. Our anaesthetist will meet you before the operation and talk you through both parts. 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.
You will then go to the operating theatre. We perform this surgery using an arthroscopic approach. This means we use two or three small incisions. A small camera goes inside the joint to guide the repair. You will wake up in recovery afterwards. Our team will monitor your comfort and ensure the pain relief from the block is working effectively.
What the operation involves
We perform this surgery using an arthroscopic, or keyhole, approach. This means we make two or three small incisions, each about 1 cm long, over your shoulder. Through these tiny openings, we insert a small camera and specialized instruments. This lets us see inside the joint on a screen without making a large cut.
Your surgeon will first examine the area to assess the previous repair. Because this is a revision procedure, you may have scar tissue or adhesions from your earlier surgery. We carefully release these tight bands of tissue to free up the shoulder structures. We also remove any retained hardware, such as old screws or anchors, that might be in the way.
Next, we prepare the tendon and bone. If the tendon is frayed or retracted, we mobilize it to ensure it can reach the bone. We then reattach the torn tendon back onto the humerus (upper arm bone) using small anchors. These anchors are fixed into the bone to hold the tendon securely in place while it heals.
Finally, we close the small incisions. We typically use dissolving sutures under the skin and may use surgical glue or steri-strips on the surface. A dressing is applied to protect the area. This approach minimizes damage to your surrounding muscles and skin compared to open surgery.
After the operation
You will wake up in the recovery ward with your arm in a sling and dressings in place. We manage pain using general methods to keep you comfortable. 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 use an arthroscopic (keyhole) approach with two or three small incisions and a small camera inside the joint. You must not drive for at least SIX WEEKS after any shoulder operation, regardless of which arm was operated on. Patients in a sling must NOT drive. Once your surgeon clears you, typically at the six-week review, you may resume driving. See our guide on Driving after upper-limb surgery.
Recovery
You will have two or three small keyhole incisions. A tiny camera helps your surgeon see inside the joint. This approach reduces tissue damage compared to open surgery. In the early days, pain and swelling are normal. We manage this with a mix of pain relief methods. An interscalene nerve block numbs the shoulder during surgery. This keeps you comfortable while you rest.
You will wear a sling to protect the repair. Do not drive while in a sling or taking strong pain medication. Our policy requires at least six weeks before you drive again, regardless of which arm was operated on. You can drive once your surgeon clears you, typically at the six-week review. See our guide on Driving after upper-limb surgery for details.
Daily activities start gently. Your physiotherapist guides your rehabilitation exercises. You will move your elbow and wrist to prevent stiffness. Shoulder movement begins slowly as healing progresses. Sleep may be difficult at first. Try sleeping slightly upright with pillows for support. Most patients find sleep improves significantly after the initial swelling settles.
Recovery is a gradual process. You will notice steady improvements in pain and function over time. Maximum recovery usually plateaus around one year. However, your timeline may differ. Your surgeon and physiotherapist will guide your specific path based on your healing progress.
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.
Re-tear of the tendon The repaired tendon may tear again. You might feel a sudden pop or snap in your shoulder. You may notice a return of weakness or pain that was previously gone. The repair might not hold as well as the first time. Contact your surgeon if you feel this shift in strength or sensation.
Infection An infection can develop in the shoulder joint or around the surgical site. You might see redness spreading out from the small cuts. The area may feel hot to the touch or look swollen. You could develop a fever or chills. You might notice pus or cloudy fluid draining from the incisions. Call the clinic immediately if you see these signs. Do not wait for your next appointment.
Blood clots (Deep-vein thrombosis) A blood clot can form in the deep veins of your leg. You may feel a deep, throbbing pain in your calf or thigh. The leg might become swollen, red, or tender. It may feel warm compared to the other leg. This is rare but serious. If you notice swelling or pain in your leg, seek urgent medical care right away.
Stiffness and limited movement You may not regain the same range of motion as you did after your first surgery. Your shoulder might feel tight or stiff. You may find it harder to lift your arm overhead or reach behind your back. The improvement in movement might be less than you hoped. Discuss your progress with your surgeon at your follow-up visits.
Need for further surgery Sometimes, the initial revision does not solve the problem completely. You might need another procedure to fix the issue. This is more common if the tissue quality is poor or if there are scar tissues from previous operations. Your surgeon will review your progress to decide if further intervention is needed.
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 or shortness of breath. Contact us immediately for loss of sensation or if you cannot move your limb. We want to ensure your recovery stays on track. Please do not drive for at least six weeks after your operation.
