Tears of the Rotator Cuff Part 3: Suture Anchor Repair of the Rotator Cuff

[@karenalberini714]

Great teaching. I was an endo nurse/tech and advanced to doing the higher risk patients in all settings of the hospital. Using wires and variois tools similar. I am impressed by your teaching and technique. It takes alot of patience and a good eye and steady hand. Always making sure tools and backup equipment were available in any situation.

[@jonathansimmons4006]

Excellent description and illustration. Well done!

[@phillipdale6765]

This was exceptional Dr Witty i and many others ..really appreciate you and your wonderful and informative information

[@JeffreyWittyMD]

Glad you found it helpful!

[@subaru7233]

Thank you Dr. Witty. It's so helpful to be able to visualize all of this. I see my surgeon in two days and will be reviewing my MRI with him. Now I'll be more knowledgeable.

[@mikekruszynski2381]

Dr. Witty, that was very well done and interesting! I’m having partial torn RC surgery next month and this gives me a great perspective on how the tear will be repaired.

[@JeffreyWittyMD]

Thanks for reaching out. Good luck with your surgery!

[@slboeshart]

I’m having rotator cuff repair December 11 and this was interesting to see how it’s done.

[@bgl500]

Really appreciate you sharing this information. My surgeon's explanation of my procedure makes a lot more sense now. Cheers

[@kathleenoshea2208]

Cool video!!! I watched this and felt so much more comfortable going in to have my surgery.

[@JeffreyWittyMD]

Awesome!

[@markthomas1911]

Great video and explanation! All 3 videos were very helpful. Thank you!

[@JeffreyWittyMD]

Thanks for watching!

[@livingtx]

Wow! Great video! Your videos are so informative and helpful!

[@JeffreyWittyMD]

Thanks so much for the feedback. Hopefully, I can continue to find time to add content!

[@DOLRED]

Thanks for sharing your technical knowledge with us, the naive simple minded patients. I am having this surgery Thursday and now know what is involved.

[@JeffreyWittyMD]

I hope everything went well!

[@jamesvosberg9354]

Thanks, you have made sense of my pictures after my surgery. Do you have any on fatty infiltrate of a chronic tear?

[@JeffreyWittyMD]

I don't have a video on that at the moment. It would be a good topic to cover at some point. Any other suggestions for topics?

[@daviddelgado6090]

Thanks for being an orthopedic surgeon. It hurt just watching it.

[@22Webstar]

This is cool to watch, just had two dry wall anchors installed on my left shoulder, had different procedure done on my right.

[@vvatc]

How do you keep the bone from cracking when tapping in the awl?

[@JeffreyWittyMD]

Good question. You have to be careful and have a steady hand!

[@modhialhajmousa]

Brilliant demonstration, thank you very much.

[@brentedwards2606]

Thanks Doc!

[@billbowen4972]

Thanks so much for a very informative video.

[@JeffreyWittyMD]

I am glad you found it helpful.

[@SoHappy20245]

Thank you so much! Very informative.

[@anshulpancholiya2477]

Beautiful demonstration.

[@azarnick1]

My surgeon did a repair after removing a huge calcification but I honestly didn't think he used an anchor at first.. "sutured side to side because the tendon was thin where the calcification was. " Great video!

[@JeffreyWittyMD]

Sometimes you don't need an anchor if you can stitch the tendon back side to side and don't need to pull it back down to the bone. That sounds like what he / she did for you. I have done this exact thing for calcific tendinitis.

[@onlyime2]

Thank you so much and I appreciate you for taking time to show the process I have 4 different ligament tears and was wondering how it's done. My sx is 7/17/24 kinda worried of pain factor, but I'm sure it can't be worse from what I have now, but it will get better with time. Thanks again.

[@JeffreyWittyMD]

Thanks for watching! I hope everything goes well with your surgery!

[@drmagedortho]

Amazing explanation

[@tjdinfl]

So interesting! Looks like I had the 3rd method done on my right shoulder. I’ve got 3 images I snapped of the computer screen while my Dr was going over what was done. I envisioned the screw to be about 3/8” in diameter. Interesting to see how tiny they are. I wish I could say my surgery was 100% successful, but it wasn’t. Better than before though.

[@animallover-lc2zh]

Great illustration of the different techniques. Clear and concise. Only con , to me, is when doing the sliding knot, it seems that doing it once or twice, then explaining it may take more knots to secure the suture, is enough to get the idea across. Don't have to actually do it 4 or 5 times. Anyway, that's me. Some questions: is there a difference as to where you put the sutures? In one example you put the sutures almost in the middle of the tendon. In another example they were close to the edge, and in another, the sutures actually come over the edge of the tendon. Does it matter where the sutures are put? Also, is it the surgeon's preference as to what type of anchor and suture method to use? Is the tear (the type and where it is) the determining factor? Is that the case as well with the type of surgery - arthroscopic or other? Can the patient have a say as to the type of surgery? By the way, what is the suture made of?? Is it like plastic fishing line (which I had in my carpal tunnel surgery back in the early 1980s)? Is it a sort of fabric? What are sutures nowadays made of? What thickness are the ones used for rotator cuff surgery? With both the knotted and not knotted examples, you stilll have to cut the suture lines away. That leaves cut ends sticking out. Even though they're tiny, they still stick/poke/irritate, I want to say, the surrounding tissue. Especially if the suture is like plastic fishing line. Had the same experience with my carpal tunnel surgery. Wouldn't that cause additional pain, especially when having to move the arm during rehab, etc.? Eventually the surrounding tissue would cover those ends, kind of like scar tissue would form (?) but in the meantime, would it add to the pain experienced? My pain threshold is really low :( just one more reason to put off surgery.) Without surgery, if the arm is immobilized for 6 months, would the tendon reattach to the bone? Would that be more likely if the tear isn't as great? Would it be likely/unlikely even with a large tear? Would it depend on where the tear was? Is there a preference, either by the surgeon or the condition of the tear, as to whether an arthroscopic surgery is done or an open?? surgery (forgot the actual term) is done? I'm in my early 70s and have a full tear of the supraspinatus in my dominant hand/arm. Trying to decide if I want to live with the pain I have now and not have surgery, or have the surgery. Went to PT for 5 weeks and it hurt more than helped. (BECAUSE... insurance co. demands you do PT first before they allow an x-ray or MRI, even though they don't know what problem the PT is supposed to "cure". Ass backwards philosophy, which actually could do more hurt than help). I stilll have use of my arm, pain is intermittent and depends on position (reaching above, behind, extended. Lifting weight depends on amount). Reviews of, and people I've spoken with who've had the surgery indicate it's an extremely painful recovery for a relatively long time - 6 months or more. Certainly not something an average person would want. But is surgery a necessity? Can I last without surgery another maybe 10 yrs, considering life expectancy (everyone in my family died before reaching 80 yrs)? Appreciate the detail you went into in your video. It's very good. Hopefully you'll see my comment and reply to my questions! If so, Thank You!!

[@JeffreyWittyMD]

I appreciate the questions. I will try and respond to each one. I'll copy your question and then respond in CAPS. Only con , to me, is when doing the sliding knot, it seems that doing it once or twice, then explaining it may take more knots to secure the suture, is enough to get the idea across. Don't have to actually do it 4 or 5 times. Anyway, that's me. WHEN WE TIE A SLIDING KNOT WE ACTUALLY HAVE TO THROW MULTIPLE KNOTS ON TOP TO HELP INCREASE THE INTERNAL FRICTION WITHIN THE SUTURE TO AVOID SLIPPAGE. TYPICALLY 3 OR SO TIMES. is there a difference as to where you put the sutures? In one example you put the sutures almost in the middle of the tendon. In another example they were close to the edge, and in another, the sutures actually come over the edge of the tendon. Does it matter where the sutures are put? IN THE VIDEO I WASN'T PUTTING THE SUTURE IN ANY LOCATION IN PARTICULAR OTHER THAN TO ILLUSTRATE THE TECHNIQUE. DURING SURGERY, WE TRY TO BE VERY STRATEGIC WHEN PLACING THE SUTURES. A TEAR CAN BE IN DIFFERENT PATTERNS, MULTIPLE PATTERNS AND HAVE VARYING DEGRESS OF STRAIN ACROSS THE TENDON. WE TRY TO PLACE THE SUTURES IN SUCH A WAY TO ACCOMODATE FOR THAT AS BEST AS POSSIBLE Also, is it the surgeon's preference as to what type of anchor and suture method to use? Is the tear (the type and where it is) the determining factor? Is that the case as well with the type of surgery - arthroscopic or other? Can the patient have a say as to the type of surgery? A GOOD SURGEON WILL WELCOME PATIENT INPUT. I WILL SAY THOUGH THAT MULTIPEL COMPANIES MAKE VERY SIMILAR TYPE SUTURES AND ANCHORS. OVERALL WE TRY TO USE THE RIGHT TOOL FOR THE JOB. SOME SURGEONS MAY USE A PARTICULAR COMPANY JUST BECAUSE OF FAMILIARITY. IN SOME CASES A COMPANY MAY HAVE A DIFFERENT PRODUCT THAT WOULD BE BENEFICIAL FOR A PARTICULAR SITUATION. Is it like plastic fishing line (which I had in my carpal tunnel surgery back in the early 1980s)? Is it a sort of fabric? What are sutures nowadays made of? What thickness are the ones used for rotator cuff surgery? IRRITATION FROM THE SUTURE IS CERTAINLY POSSIBLE. IN ABOUT 10 YEARS OF PRACTICE I HAVE HAD ONE PATIENT I HAD TO GO BACK AND TAKE A KNOT OUT. OTHERWISE, I HAVE NOT NOTICED ANY DIFFERENT BETWEEEN THE "KNOTLESS" AND THE SUTURES YOU HAVE TO TIE. EACH TECHNIQUE HAS ITS OWN BENEFITS. I BELIEVE THE SIZE OF THE SUTURES IN THE ANCHORS IS NO.2 BUT THE WIDER TAPES ARE AROUND 2MM THICK I BELIEVE. THE SUTURES ARE NOT LIKE MONOFILAMENT FOR FISHING. THERE ARE SURGICAL SUTURES THAT ARE SIMILAR BUT THESE ARE MORE FIBER LIKE AND NOT AS "PRICKLY". ad the same experience with my carpal tunnel surgery. Wouldn't that cause additional pain, especially when having to move the arm during rehab, etc.? Eventually the surrounding tissue would cover those ends, kind of like scar tissue would form (?) but in the meantime, would it add to the pain experienced? My pain threshold is really low :( just one more reason to put off surgery.) IF YOU HAVE THE OPPORTUNITY TO GO BACK INTO A SHOULDER THAT HAS A SUCCESSFUL REPAIR (FOR A DIFFERENT REASON PERHAPS) THE TENDON CAN HEAL RIGHT OVER THE SUTURES AND THEY ARE PRETTY WELL COVERED. ITS CERTAINLY POSSIBLE THAT SOME PAIN FROM THE SUTURE ENDS COULD OCCUR BUT I THINK THIS IS RARE. Without surgery, if the arm is immobilized for 6 months, would the tendon reattach to the bone? Would that be more likely if the tear isn't as great? Would it be likely/unlikely even with a large tear? Would it depend on where the tear was? FOR A SIGNIFICANT ROTATOR CUFF TEAR THE CHANCE OF IT HEALING BACK TO BONE IS VERY LOW. ONE OF THE BIG CONCERNS WITH SUCH TEARS IS THAT THE TENDON TEAR CAN ACTUALLY GET BIGGER AND BEGIN TO RETRACT INTO THE SHOULDER MAKING REPAIR MORE DIFFICULT. THE MUSCLE CAN ALSO ATROPHY IN THOSE SITUATIONS. Is there a preference, either by the surgeon or the condition of the tear, as to whether an arthroscopic surgery is done or an open?? surgery (forgot the actual term) is done? CURRENTLY, I WOULD GUESS THE VAST MAJORITY OF ROTATOR CUFF TEARS ARE DONE IN AN OPEN MANNER. OPEN MEANS THAT THE SURGERY IS PERFORMED THROUGH A LARGE SURGICAL INCISION AND NOT THROUGH MULTIPLE SMALLER HOLES WITH ASSISTANCE OF THE CAMERA (ARTHROSCOPY). YOU CAN FIX EVEN VERY LARGE TEARS ARTHROSCOPICALLY. Hopefully, this answers the majority of your questions. I will try and get back to the others. All the best. _______________________________________________________________________ Please understand that this does not represent the formation of a formal doctor patient relationship and is for educational purposes only. All comments should be considered as informal suggestions regarding any matters of medical care. Please also be aware that this is a public forum and any information you share is not secure.

[@vijaykumarubale7110]

Very nice demo

[@JeffreyWittyMD]

Thank you!

[@rmstekel]

Thanks for the video. I have a supraspinatus tear, and I’m considering surgery or not. My question : does the tendon,when repositioned by the sutures, actually reattach to the bone with time ? Or it’s just the sutures the will hold it on place ? I’m 52. Thank you

[@JeffreyWittyMD]

Thanks for your question. Good question. The repair sutures hold the tendon in place until the tissue heals back to bone. This takes time which is why we use a sling after surgery and have restrictions regarding activity. After enough time has passed, the strength of the tendon where it has healed to bone will tolerate the load through the shoulder.

[@JaguarJim]

​@@JeffreyWittyMD I have same tear . Not sure how many anchors he is going to use. I'm afraid to ask .

[@stevemerrill7430]

Does putting a suture through the tendon weaken the tendon? Very good video. I had a full tear repair on my left shoulder in October 2022, right one is next.

[@JeffreyWittyMD]

Thanks for the question. The sutures are pretty small and don't really affect the tendon. I suppose you could put a LOT of sutures through the tendon and that could cause a problem. During surgery we use enough to hold the tendon securely without overdoing it. The bigger issue can actually be room on the bone for the actual anchors to "anchor". There is only so much real estate and you have to be strategic when deciding the best location for fixation and counter-acting the forces across the tendon. Anchors sizes can vary depending on the needs of the surgery, quality of the bone etc.

[@vpp9643]

Great video! Is there any risk that the anchors come out? I'm a volleyball player and I just had the rotator cuff repaired (2 tears, 1 in suprasupinatus, 1 in infrasupinatus). There are 2 PEEK anchors.

[@JeffreyWittyMD]

Thanks for the question. The chance of an anchor pulling out is very low. I have only seen it happen after a patient actually fell onto the shoulder right after surgery!

[@rocksta_24]

After the surgery will the impact like suture anchor and fibers be visible through an Xray or CT scan?

[@georgewong1888]

Will the degree of tear get worse over time if surgery is not done ?

[@JeffreyWittyMD]

This is an important question. The answer is that "it depends". Smaller / incomplete tears may not get bigger in size. However, larger tears can indeed get bigger with time. If the tears get bigger the tendon may retract further from the attachment site on the humerus. The muscle attached to the tendon can also atrophy over time as well. A detailed review of your MRI with an ortho surgeon can help you understand your particular injury. _______________________________________________________________________ Please understand that this does not represent the formation of a formal doctor patient relationship and is for educational purposes only. All comments should be considered as informal suggestions regarding any matters of medical care. Please also be aware that this is a public forum and any information you share is not secure. All patients have been consented for use of any imaging, video, or other media.

[@SuzanneLiberty]

Just had mri ,going to surgeon soon.2 complete tears one of the sup and one of in .. .muscles..(sorry can't pronounce the actual names) they retracted back to rhe Hemral

[@husamtahan1]

any info on where i can order the shoulder model u got ?

[@JeffreyWittyMD]

I had a colleague give me the model. Not sure where they got it. I bet you can find on Amazon.

[@arphaksad01]

Why not drill a pilot hole?

[@JeffreyWittyMD]

Good question, We use the awl because it compacts the bone (instead of removing bone) around the pilot hole which allows for better purchase of the anchor into the bone.

[@arphaksad01]

@@JeffreyWittyMD OK. Makes sense. The bone walls are denser than normal. Thanks

[@HarryB916]

How long is recovery time after surgery ?

[@JeffreyWittyMD]

Thanks for the question. I usually quote about 6 months of time before people are fully released for unrestricted activity. Keep in mind that each injury is unique and every patient is different and they may take different amounts of time to get back to their desired activity. In general, I use a sling for 6 weeks after surgery, strengthening at 12 weeks after surgery and then about 6 months I am looking to see if people are ready to be fully released. Also, different patients have different activity demands (think an athlete vs sedentary person). This will potentially add the time it takes to develop the strength and skill that particular sport/activity/work requires. ___________________________________________________________________________ Please understand that this does not represent the formation of a formal doctor patient relationship and is for educational purposes only. All comments should be considered as informal suggestions regarding any matters of medical care. Please also be aware that this is a public forum and any information you share is not secure.

[@HarryB916]

@@JeffreyWittyMD would you recommend this surgery for a 76 year old man ?

[@eunicejames5330]

I just had rotator cuff surgery six days ago . Now I know why it hurt so much post op. There is a lot going on. Thank for the video, it really helps.🦴😢

[@JeffreyWittyMD]

The first week after shoulder surgery can definitely be tough! Things should keep getting better each week. Just take it a day at a time. Hang in there and good luck!