Revision rotator cuff repair Info Consent
Reviewed by Dr Kieran Hirpara, Specialist Orthopaedic Surgeon Last reviewed
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 long-standing problems we usually try non-operative care first. We consider surgery when that has not given enough improvement.
Your surgeon may recommend this procedure if you still have pain and stiffness despite other treatments. This operation aims to repair a torn shoulder tendon that failed to heal previously. It can provide significant pain relief and better shoulder function at five years. However, outcomes are not as good as a first-time repair. You are twice as likely to have the tear come back by two years. We discuss these results openly so you can make a shared decision about your care.
Before the operation
If you have other medical conditions, you may need blood tests or a review with the anaesthetist before surgery. An MRI may be required to map the tear. Please fast for seven hours before your arrival. Stop specific medications only as directed by your surgeon. Arrange for a responsible adult to drive you home and stay with you overnight. Bring a complete list of all current medicines and supplements. Wear loose, comfortable clothing that allows easy access to your shoulder. These steps help ensure a safe procedure and a smooth start to your recovery.
On the day
You will present to the hospital’s surgical admissions unit. You are checked in and prepared for theatre. You meet the anaesthetist. 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
Your surgeon performs this procedure using an arthroscopic, or keyhole, approach. This involves making two or three small incisions, each about 1 cm long, over your shoulder. Through these tiny openings, your surgeon inserts a small camera and specialised instruments. This allows us to see inside the joint on a screen without needing a large cut.
The main goal is to reattach your torn tendon back onto the bone. In most cases we use the same double-row repair as a first-time repair. Soft suture anchors go into the bone at the inner edge of the tendon's footprint, their stitches are passed through the tendon, and those stitches are then secured further out by a second row of strong medical-grade plastic anchors, which holds the tendon down against the bone. Depending on what we find during the surgery, we might adjust the plan: a single-row repair may be used instead, or screw-in plastic anchors for the inner row if the bone or tissue quality calls for it.
We also often place a biological scaffold under the tendon at the repair site to encourage it to heal back onto the bone. You can read about this in EnFix biological scaffold.
Because this is a revision surgery, the tissues may be tighter or scarred from your previous operation. Your surgeon will carefully release any adhesions and mobilise the tendon to ensure it can reach the bone properly. This step is crucial for a successful repair. Once the tendon is in place and secured, the small incisions are closed with stitches, and a dressing is applied.
After the operation
You will wake up in the recovery ward with your arm in a simple sling for comfort. We manage pain using a multimodal approach to keep you comfortable without relying solely on strong opioids. Most patients stay one night in hospital after this operation, though some are able to go home the same day. You must have someone stay with you for the first 24 hours. Keep the dressing dry and clean. You will not need a special brace; just the sling. Do not drive for at least six weeks, regardless of which arm was operated on. Your surgeon will clear you to drive at your six-week review. See our guide on Driving after upper-limb surgery for more details.
Recovery
Your shoulder will feel stiff and sore in the first few days. This is normal. We manage this pain with a combination of nerve blocks and medication tailored to your needs. Swelling is also common. Keep your arm elevated when resting to help reduce it. Your arm will be supported in a simple sling for comfort. You can remove it for gentle exercises and washing, but keep it on otherwise.
Recovery is a gradual process. You will start physiotherapy soon to restore movement. Your physiotherapist will guide you through specific exercises to rebuild strength. Do not push through sharp pain. Focus on smooth, controlled movements. As the swelling settles and your range of motion improves, you will notice daily tasks becoming easier. Sleep may still be difficult at first. Try sleeping on your back or the unaffected side with a pillow supporting your operated arm.
Most patients find they can return to driving once they are cleared by your surgeon, typically at the six-week review. You must not drive while wearing a sling. Your timeline may differ from others; your surgeon and physiotherapist will guide you based on your individual 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-tearing the tendon is a known risk, especially with revision surgery. You might notice a return of weakness or pain that feels similar to your original symptoms. If your shoulder starts to feel unstable or weak again, contact our clinic for an assessment.
Infection is a rare but serious complication. You may experience increasing redness, warmth, or swelling around the shoulder. A deep, throbbing pain that does not ease with simple painkillers can also be a sign. If you develop a fever or notice drainage from the wound, seek medical attention immediately.
Blood clots in the leg (deep-vein thrombosis) are uncommon after shoulder surgery. You might feel sudden swelling, tenderness, or pain in your calf or thigh. If you notice these symptoms, go to the emergency department right away.
Stiffness and limited movement are possible, particularly after revision procedures. You may find it harder to lift your arm or reach behind your back than expected. Discuss any concerns about your progress at your next review so we can adjust your rehabilitation plan.
Implant issues can occur if you have had a shoulder replacement. You might hear or feel a clicking, grinding, or popping sensation in the joint. If this is accompanied by new pain or instability, contact our team for evaluation.
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, worsening redness or discharge from your wound, or sudden severe pain. Go to emergency if you notice calf swelling or shortness of breath, which may signal a blood clot. Seek urgent care for loss of sensation or inability to move your limb. We are here to help if these symptoms arise.
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
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.
