The procedure can be performed in two different ways.

Arthroscopic Surgery – Most rotator cuff repairs are accomplished using incisions that minimize cosmetic changes in the skin following healing. A narrow, tubular instrument called an arthroscope is inserted. The arthroscope is equipped with a tiny camera, and the surgeon uses small instruments inserted through very small incisions. If bone spurs, adhesions and damaged bursa are present in the rotator cuff region, the surgeon will generally remove these damaged structures to improve function in the joint.

The surgeon performs the procedure while watching live images of the surgery on a monitor. This procedure is usually performed when there is a small tear.

Open Surgery –The surgeon makes a large incision over the shoulder. The torn tendon is mended and reattached and/or anchored with stitches. The incision is then closed with stitches or staples.

The success of the rotator cuff repair is dependent on the following factors:
• age of the patient
• type of surgical technique employed
• degree of damage present
• patient's recovery goals
• patient's ability to follow a physical therapy program following surgery
• smoking status
• number of previous cortisone injections

The procedure takes about one and a half hour to two hours to complete.

The prognosis for the long-term relief from rotator cuff syndrome is good, especially when both conservative and surgical therapeutic approaches are used. In those patients who do require surgery, 6 weeks of physical therapy is typically instituted following surgery. Complete recovery following surgery may take several months.

In rare cases, the rotator cuff injury is so severe that the patient may require muscle transfers and tendon grafts. Even more rarely, the injury can be so severe that the tendons are not repairable. This typically occurs when a severe rotator cuff injury is neglected for a long period of time.

Before planning for the surgery, get familiar with reasons for performing it. Rotator cuff surgery is necessary when chronic shoulder pain associated with rotator cuff injury does not respond to conservative therapy such as rest, heat/ice application or the use of non-steroidal anti-inflammatory drugs (NSAIDs). Rotator cuff injuries are often lumped into the category referred to as rotator cuff syndrome. Rotator cuff syndrome describes a range of symptoms from basic sprains and tendon swelling (tendonitis) to total rupture or tearing of the tendon.

Once you have decided to undergo the surgery, you should:

• Stop smoking and get your weight down if you are overweight.
• Consult your doctor to control your problems with your blood pressure, your heart, or your lungs.
• Consult your surgeon regarding any pills or hormone replacement therapy (HRT).
• Have a relative or friend who can come with you to the hospital, take you home, and look after you for the first week after the operation.
• Inform your surgeon about the medication that you are having.
• You may be checked for past illnesses and may have special tests, to make sure that you are well prepared for the surgery.
• Do not take aspirin, aspirin-containing products, or anti-inflammatory drugs (eg, ibuprofen) for one week before the procedure
• Do not eat or drink anything for 12 hours before surgery
• Arrange for a ride to and from the procedure
• Remove contact lenses and jewelry while operation
• You may have the following on the day of the surgery:
o Blood drawn for testing
o A chest x-ray
o An electrocardiogram

Undergoing the surgery, you will have a general anesthetic and will be asleep for the whole operation.

The possible risks from the procedure are:

• Infection which can be controlled by antibiotics
• Bleeding
• Reaction to prescribed medication
• Scarring within the shoulder joint
• The operation does not provide the desired improvement in function
• Instrument breakage
• Blood vessel or nerve damage which might need another operation to deal with the problem.
• Blood vessel clots
• Inflammation
• Cardiac problems
• Stiff shoulders in case of removing overhanging bone

However, the tests that you will have before the operation will make sure that you can have the operation in the safest possible way and will reduce the risk.

After the surgery, the incision will be bandaged to prevent infection.
Your arm will be placed in a sling to prevent movement. You may experience some pain, but this can be controlled by medication.

Following the procedure, the patient will typically spend several hours in the recovery room. The dressing is usually removed the day after surgery and is replaced by adhesive strips. Generally, an ice pack will be applied to the affected shoulder joint for a period up to 48 hours. The patient will usually be given either prescription or non-prescription pain medication. However, you should keep the bandage clean and dry at all times.

The patient should contact a physician if there are any significant changes in the affected area once the patient goes home. These changes can include increased swelling, pain, bleeding, drainage in the affected area, nausea, vomiting, or signs of infection. Signs of infection include fever, dizziness, headache, and muscle aches.

It often takes several days for the arthroscopic puncture wounds to heal, and the joint usually takes several weeks to recover. You should not use the arm until after the sling has been removed.
Most patients are advised to undergo a rehabilitation program that includes physical therapy in order to speed up the recovery.