I’ve been told that an open repair of my torn rotator cuff may give the best long-term results. But I like the idea of a smaller incision with the less invasive operations. Is the open method really so superior that I should take the cut?

The open rotator cuff repair has been the standard operation for many years. Long-term studies show it has an 85 to 95 per cent success rate. Patients experience pain relief and improved function.

At the same time, arthroscopic surgery has made it possible to do a mini-open rotator cuff repair. This procedure still provides good pain relief and even better functional results. Studies show 93 per cent improved function at mid-term follow-up.

Studies comparing the two methods still conclude that the open repair has the best long-term results. The success of the operation depends on three basic factors. These include the strength of the tendon-to-bone fixation, strength of the suture, and strength of the suture-to-tendon fixation.

Failure of fixation after the first rotator cuff repair occurs in 13 to 68 per cent of all cases. The wide variability in this failure rate is affected by these three factors. Results after re-repair aren’t very good. There’s only a 20 per cent chance of a good to excellent result.

Using the right sutures and suture placement is important in getting a fixation strength that’s equal to or greater than the force of the muscle pull. An open repair makes it possible for the surgeon to see everything more clearly and make the best repair for the damage present.

Massive rotator cuff tears are still largely done with the open method. Arthroscopic techniques are confined to small tears that can be repaired easily.