Revision rotator cuff repair can be performed using either arthroscopic (minimally invasive) or open (traditional incision) approaches. Each method has distinct benefits, limitations, and ideal use cases, and the choice often depends on tear complexity, tissue quality, and prior surgical history.
Arthroscopic Revision Repair
Advantages
- Minimally Invasive: Uses small incisions and a camera for visualization, reducing soft tissue disruption.
- Better Visualization: Allows access to all areas of the joint, including hidden or partial tears.
- Lower Infection Risk: Smaller incisions reduce infection rates compared to open surgery.
- Simultaneous Procedures: Surgeons can address associated problems such as biceps pathology or labral tears in the same setting.
Limitations
- Technically more demanding in revision cases due to scar tissue and distorted anatomy.
- May not be ideal for massive tears requiring significant tendon mobilization or reconstruction.
Open Revision Repair
Advantages
- Direct Access: Provides a clear view and direct handling of the rotator cuff and bone.
- Strong Repair Potential: Ideal for large, complex tears or when tendon transfers are needed.
- Better for Graft Placement: Allows easier handling of large biologic or synthetic grafts.
Limitations
- Larger incision with more soft tissue disruption.
- Slightly higher infection risk and longer healing time.
- May limit early range of motion compared to arthroscopic techniques.
Choosing the Right Technique
The decision often depends on:
- Tear Size & Pattern: Larger or more complex tears may require open repair.
- Tissue Quality: Severely degenerated tissue may be easier to address with open access.
- Surgeon Expertise: Both approaches require advanced skills—surgeons often choose based on their strongest technique.
- Concurrent Procedures: Arthroscopy is better suited for treating multiple shoulder pathologies in one surgery.
Summary Table
| Feature | Arthroscopic Revision | Open Revision |
| Incision Size | Small | Larger |
| Visualization | Camera-assisted, full joint | Direct, localized |
| Recovery | Often faster | Slightly longer |
| Ideal for | Smaller to moderate tears, multi-pathology cases | Large, complex tears, graft placement |
| Technical Demand | High | Moderate to high |
Frequently Asked Questions
1. Is one approach more successful than the other?
Success depends more on surgical execution, tear type, and tissue quality than on the approach itself.
2. Does arthroscopy always mean faster recovery?
Usually, but the complexity of the tear and patient healing factors still play a role.
3. Can a surgeon switch from arthroscopic to open during surgery?
Yes—if visualization or access is inadequate, the procedure may be converted for safety and effectiveness.
4. Which approach has fewer complications?
Arthroscopy tends to have fewer wound-related issues, but both can be safe in experienced hands.5. Are grafts only used in open revision?
No—arthroscopic graft augmentation is possible, but large grafts are easier to handle via open repair.
