The rotator cuff is a group of 4 tendons (the supraspinatus, infraspinatus, subscapularis and teres minor) that surround the top of the arm bone (humerus) where it meets the cup of the shoulder joint (glenoid) and help to stabilize the shoulder joint as well as abducting and rotating the arm. When these ligaments are damaged, arthroscopic rotator cuff repair can help restore function and eliminate pain.
Damage to the rotator cuff can occur as the result of a traumatic event in young patients or simply due to degeneration of the tendon tissue in older patients. When the rotator cuff is torn, a variety of treatment options may be considered based on the type, location and extent of the tear. These options may be non-operative, typically a several week course of physical therapy aimed at reducing pain and inflammation while restoring full range of motion and strengthening both the rotator cuff and muscles surrounding the shoulder blade. Other tears may require surgical intervention in the form of an arthroscopic rotator cuff repair. This involves inserting a camera as well as a series of small tools through portals in the shoulder.
During surgery, the doctor will first examine your shoulder joint to visualize the torn part of the rotator cuff before cleaning out the torn tissue and inserting anywhere from 1 to 4 composite, bio-absorbable anchors into the top of the humerus. These anchors are made of tricalcium phosphate (coral) and are gradually absorbed by the body over time, long after the tear has healed. Sutures attached to these anchors are then passed through the torn rotator cuff and used to secure it back in place. These operations will typically include a procedure known as a subacromial decompression, in which the surgeon will shave off the underside of the acromion (the pointy bone on the outside of your shoulder). This helps to free up extra space for the rotator cuff and essentially bathes the new repair in bone marrow- your body’s own stem cells.
Partial RCR
Partial rotator cuff repairs present a unique pathology that must be treated accordingly. The rotator cuff is composed of 2 layers- a bursal side on top and an articular side on the bottom. When one of these layers becomes diseased or damaged while the other layer remains healthy, this is known as a partial rotator cuff tear. These can occur in 1 of 3 locations- the articular side, the bursal side, or between the 2 layers- known as an intrasubtance tear. Each tear type poses its own unique challenges in treatment, as they must each be repaired using separate techniques.
Bursal sided tears can be fixed using a relatively simple repair method by passing suture through the part of the tendon that has pulled away from the bone and re-approximating the tendon to 1 or 2 anchors inserted within the bone.
Articular sided tears can be more difficult to treat, as they occur on the underside of the tendon rather than the top side. This can make accessing and repairing the tendon more difficult, and many techniques require cutting through the intact bursal side of the rotator cuff in order to repair the tear, essentially creating a full-thickness rotator cuff tear. This is where Dr. Spencer’s innovation has come into play. By developing a unique surgical technique, he managed to offer a repair strategy that allows for repair of these tear patterns without having to cut through any of the healthy tissue. This allows for a much more efficient and anatomically-correct repair mechanism that has been shown to improve patient satisfaction and functional outcomes. The initial publication is included below, along with a video demonstrating this technique during arthroscopic surgery.
Intrasubstance rotator cuff tears also post a unique challenge in treatment, as both the articular AND bursal layers remain intact, but a tear between the 2 develops and can cause pain and loss of function. Repairing these types of tears would potentially involve cutting through at least 1 healthy layer of tissue in order to repair the defect. To combat this problem, Dr. Spencer has conducted research on the effectiveness of treating these tears with a platelet rich plasma (PRP) injection. This treatment method offers a non-surgical method for treating these tear patterns using the body’s own healing mechanisms, offering a far less invasive and much less costly treatment option. The study, published in 2023, is available below. Additional information on PRP is available at the bottom of this page as well as our research page.
Rotator Cuff Repair
RCR with biceps tenodesis
When treating rotator cuff tears, it is fairly common to find additional damage to the biceps tendon that also requires surgical correction. The surgical technique for this repair usually involves the use of additional suture anchors as well as extra time to complete the repair before finally repairing the rotator cuff. However, Dr. Spencer has developed a surgical technique for this repair type that requires no additional hardware, takes considerably less time, and provides a very strong repair of the biceps tendon. This allows for faster and less costly repairs that maintain patient satisfaction and functional outcomes after surgery. His research team has published a review of 200 patients that underwent this type of repair and found that surgical outcomes were on par with the typical repair methods, but required less time and reduced the cost of implants used. This paper is available below as well as our research page, and is followed by a video of the procedure being performed arthroscopically.
Research and Patient Education
As a leading expert in the field of rotator cuff repair, Dr. Spencer and his team have continued to conduct research on the effectiveness of numerous treatment options to ensure we are providing top notch care that incorporates the latest in evidence-based medicine in addition to pioneering novel surgical techniques that provide better treatment options for a number of different pathologies. These allow for more specific, effective, and lost costly treatment options that optimize patient outcomes. His most recent publications have focused on the treatment of various types of rotator cuff repair techniques, and more information on these techniques can be found on our research page.
Additional information on PRP is available here.
A top surgeon in Tennessee, Dr. Spencer utilizes a variety of treatment methods to address shoulder problems. If you need an appointment, visit our Homepage to request an appointment at one of our Knoxville clinics!