The Philosophy of Arthroscopic Rotator Cuff Repair

Abstract

The philosophical considerations that have driven the evolution of rotator cuff surgery toward the arthroscopic approach have included the following: maximizing visualization, minimizing iatrogenic tissue damage, recognizing pathoanatomy correctly, and optimizing repair constructs. The arthroscope has allowed the surgeon to demonstrate rather than speculate about the reparability of radiographically intimidating tears and strive toward shoulder joint preservation over sacrifice in the absence of glenohumeral arthritis. These tenets have spurred a technical revolution over the last 25 years with great benefits for patients and surgeons. Alternatively, for surgeons who accept the burden of the craft of rotator cuff surgery, the arthroscope brings significant challenges in gaining mastery of novel and advanced techniques.