A number of factors need to be considered:
- the amount of pain caused by the torn tendon
- your age and level of activity
- the condition of the torn tendon and muscle
The amount of pain a torn tendon causes, and the response you have had to the various non-surgical means of treatment is by far the most important factor in determining whether surgery is required. It is often pain at night disturbing sleep on a regular basis that seems to make people consider surgery.
Age of the patient at time of surgery seems to be one of the most important in determining whether a repaired tendon will heal or not.
For patients under the age of 50 – 55 years
Few patients under the age of 50 – 55 will have a torn rotator cuff, and this will almost always be traumatic in nature. Surgery in these patients needs to be considered early.
For patients between the ages of 55 and 70 years
Using modern arthroscopic (key-hole surgery) techniques, most torn rotator cuffs are repairable. The arthroscope allows for better visualisation and mobilisation of the tear pattern, how to best repair it, better access to put in anchors and sutures for the repair, double-row technique to provide secure fixation of the tendon back onto bone; all without interfering with the deltoid muscle.
But just because a tear is repairable, that does not mean that it should be repaired. Not all repaired tendons will HEAL back to bone again.
The tear should not be considered in isolation. A careful assessment of the likelihood of healing needs to be made. Pre-existing medical conditions need to be taken into account. A thorough shoulder exam will determine whether it is appropriate to consider repair of the torn tendon. Additional imaging can be very valuable in determining the likelihood of functionality following a rotator cuff repair.
After the age of 70 years
In most patients over the age of 70 years, the rotator cuff muscle and tendon will often have pre-existing changes within it. Often a tear becomes painful with little further injury. Although most tears may still be repairable, unfortunately they may not heal once repaired. For this group of patients other arthroscopic (key-hole surgery) techniques may be more appropriate. Alternative treatment may result in quicker recovery time, and better outcomes.
Any surgical or invasive procedure carries risks. Before proceeding, you should seek a second opinion from an appropriately qualified health practitioner.