Who Repairs Rotator Cuffs in Bethesda?

Overview

Arthroscopic rotator cuff repair reattaches a torn tendon to the humerus through small portals, without opening the shoulder. It treats a symptomatic full-thickness tear that has not responded to nonoperative care or is unlikely to improve without surgery. Dr. Raffo has performed over 2,000 rotator cuff repairs; the right candidate and expected outcome depend heavily on tear size and age.

This page covers who is a candidate, how the operation is performed, construct choice, and honest retear rates by tear size and age.

Who this is for

A rotator cuff repair is appropriate for patients with a symptomatic full-thickness tear confirmed on MRI or ultrasound, particularly when there is night pain, weakness with overhead activity, or a tear that is enlarging over time. Left untreated, tears do not reliably stay the same size: in one prospective cohort, 49% of tears enlarged over a median 5.1 years, and muscle degeneration developed in 30% of tears that enlarged versus 4% of tears that stayed stable (Keener, JBJS Am 2015). At 10 years of observation, the AAOS 2025 Clinical Practice Guideline reports that tear size increased more than 5 mm in 59% of untreated tears and more than 10 mm in 41%, with substantial muscle atrophy in 49% and fatty degeneration in 41% (AAOS 2025 CPG).

Surgery is not automatically the right answer for everyone with a torn cuff. Patients with small or medium tears and mild symptoms, patients who are poor surgical candidates medically, and patients whose primary limitation is stiffness rather than a structural tear are often better served starting with physical therapy. For small and medium tears specifically, the AAOS 2025 CPG reports that surgery still outperforms physical therapy at 10 years — a Constant score advantage of 9.6 points and an ASES advantage of 15.7 points (AAOS 2025 CPG) — but that is a difference worth discussing, not an emergency. Patients in the Bethesda and Germantown area who want to try therapy first are routinely referred for a structured rehabilitation program before any surgical decision is made.

How I approach it

I don't operate on every torn rotator cuff I see, but I also don't let a tear sit indefinitely once someone is symptomatic. If a patient has a full-thickness tear and real functional limitation, I lay out the trajectory plainly: tears in this category tend to progress rather than heal on their own, and the tissue and muscle quality I'm working with gets worse the longer a tear goes unrepaired. I use double-row or transosseous-equivalent suture-bridge constructs for most tears, and I've moved away from single-row fixation except in select small tears with excellent tissue, because the healing advantage of double-row is real and concentrated in the tears where it matters most — a pooled odds ratio of 13.00 in tears 3 cm or larger, versus a more modest signal in smaller tears (Orthopaedic Journal of Sports Medicine 2023).

Age and tear size drive my counseling more than any other variables. I tell patients in their 70s that healing rates on imaging are meaningfully lower than in their 40s — in one large single-surgeon series, retear rose from 5% under age 50 to 25% at 70–79 and 34% at 80 and older (Diebold, JBJS Am 2017) — but I also tell them that a retear is not the same thing as a failed operation. In the landmark Galatz series, 17 of 18 large and massive repairs re-tore on ultrasound, yet the average ASES score at two years was 79.9 (Galatz, JBJS Am 2004). Most of my older patients get meaningful pain relief even when the tendon does not fully heal on imaging; where they lose ground is strength, not comfort.

The operation

The repair is performed arthroscopically through several small portals around the shoulder. A camera and instruments are used to remove damaged bursal tissue, prepare the bone surface where the tendon will reattach, and pass sutures through the torn tendon edge. Suture anchors are placed in the humeral head, and the tendon is pulled back down to its footprint and secured — typically with a double-row or suture-bridge construct that recreates a broader area of tendon-to-bone contact than a single row of anchors. Concomitant procedures such as biceps tenodesis, subacromial decompression, or debridement of arthritic changes are addressed in the same setting when indicated. Open and mini-open techniques remain available and produce comparable long-term outcomes to arthroscopic repair — the AAOS 2025 CPG describes long-term results as similar between approaches, and in one randomized trial healing rates were identical (40%) in both groups (AAOS 2025 CPG) — but the arthroscopic approach is used for the large majority of primary repairs in this practice.

Risks and honest tradeoffs

The most common way a rotator cuff repair "fails" is a retear rather than a complication in the traditional sense. Pooled retear rates across the literature run around 22% (Khazzam, JSES International 2020; Haque, Shoulder & Elbow 2017/2018), with the AAOS 2025 CPG citing 21% at one year, 28% at five years, and 34% at ten years (AAOS 2025 CPG), and reported figures elsewhere in the literature ranging as widely as 13% to 94% depending on tear size and how retear is defined (current concepts review, 2021). Retear risk rises sharply with tear size: 12-month healing in one cohort was 66% for small tears, 68% for medium, 47% for large, and 27% for massive (Rashid, Acta Orthopaedica 2017).

A retear does not mean the surgery failed the patient. Intact repairs outperform retorn ones by a real but modest margin — Constant score 8.61 points higher, ASES 9.49 points higher — differences that are statistically significant but often below what a patient can feel day to day (Haque, Shoulder & Elbow 2017/2018). Where retear does bite is strength: supraspinatus strength recovery is 73% in retorn shoulders versus 86% in intact ones (P=.018) (Kim, Orthopaedic Journal of Sports Medicine 2023).

True complications are uncommon. Overall complication rates run about 10.5% for arthroscopic and 10.6% for open repair (systematic review). Postoperative stiffness affects roughly 7.3% of patients at 12 weeks, falling to 1.6% by one year (Schneider, JSES International 2020). Deep infection is rare — reported at 0.3% to 1.9% in a broader review (World Journal of Orthopedics review), and as low as 0.11% (2 of 1,773 repairs) in one large single-institution series (Singh, Arthroscopy Sports Medicine and Rehabilitation 2021). Return to work averages about 62.3% of workers returning to their prior work level at a mean of 8.15 months, with more than a third not returning to their prior level at all (Haunschild, AJSM 2021).

Recovery and rehabilitation

Recovery from an arthroscopic rotator cuff repair is measured in months, not weeks, because tendon-to-bone healing is the limiting factor regardless of how quickly pain improves. Most patients wear a sling and avoid active use of the arm for four to six weeks while the repair heals, with passive motion typically starting within that same early window. Active exercises begin after the sling period, and strengthening starts around eight to twelve weeks. Most patients reach functional motion and adequate strength by four to six months (OrthoInfo: Rotator Cuff Tears — Surgical Treatment Options). The AAOS 2025 CPG notes that early mobilization protocols (starting at 0–2 weeks) and delayed mobilization protocols (4–8 weeks) produce similar outcomes overall (AAOS 2025 CPG), so the exact sling duration is often tailored to tear size and construct rather than fixed for everyone.

Recovery milestones:

• Weeks 0–6: Sling worn continuously; passive range of motion started early; no active lifting with the operative arm.
• Weeks 6–8: Sling discontinued; active-assisted and active range of motion progressed.
• Weeks 8–12: Strengthening program begins.
• Months 4–6: Most patients reach functional motion and adequate strength for daily activities.
• Months 6–12: Return to full sport or heavy manual labor for patients cleared for it; return-to-work data show a mean of about 8.15 months for a full return to prior work level (Haunschild, AJSM 2021).

1. Weeks 0–6

   Sling worn continuously; passive range of motion started early; no active lifting with the operative arm.

2. Weeks 6–8

   Sling discontinued; active-assisted and active range of motion progressed.

3. Weeks 8–12

   Strengthening program begins.

4. Months 4–6

   Most patients reach functional motion and adequate strength for daily activities.

5. Months 6–12

   Return to full sport or heavy manual labor for patients cleared for it.

   return-to-work data show a mean of about 8.15 months for a full return to prior work level (Haunschild, AJSM 2021).

Alternatives I considered

For patients who are borderline candidates — a small or medium tear, a lower-demand lifestyle, or medical risk that makes surgery less attractive — I discuss structured physical therapy as a genuine first step rather than a formality. The Bethesda-area physical therapy programs I refer patients to focus on rotator cuff and periscapular strengthening, and a meaningful subset of patients improve enough that surgery is deferred or avoided entirely. Where I don't offer physical therapy as a serious alternative is a large or massive tear with significant weakness, or any tear that is already enlarging on serial imaging, because the natural history data show those tears rarely get better on their own and often get harder to fix the longer they're left (Keener, JBJS Am 2015).

Biologics used