Informed Surgery
Patient guide

Rotator cuff repair, explained

Rotator cuff tears are very common, especially after 50, and many people live with one without knowing. This guide covers when surgery helps, when exercise may do as well, what the operation involves, and why recovery takes the better part of a year.

Independent and sourced. Written by a non-physician author with a medical device background, and not reviewed by a physician. Not medical advice. Last reviewed November 2026. How we write these guides.

The short version

  • Not every tear is the same. A sudden tear from an injury, especially in a younger person, is a different problem from slow wear in an older shoulder.
  • For mostly small, wear-related tears, a Cochrane review found surgery may give little or no extra benefit over exercise at one year, though the evidence is uncertain.[1]
  • Over a longer horizon, one trial found repair of small and medium tears gave better results than physical therapy at 10 years, and the gap grew over time.[2]
  • Repaired tendons don't always heal. Across high-quality studies, roughly 15 to 21% of repairs had re-torn on imaging, depending on when they were checked.[5]
  • Shaving bone from under the shoulder blade (decompression) for shoulder pain without a full tear did no better than placebo surgery in a large trial.[4]

What the rotator cuff is

The rotator cuff is a group of four muscles whose tendons wrap around the ball of the shoulder (the top of the upper arm bone). They keep the ball centered in its shallow socket and help lift and rotate the arm. The tendon most often torn is the supraspinatus, which runs over the top of the shoulder.

Tears can be partial (frayed but not all the way through) or full-thickness (a hole through the tendon). Full-thickness tears are described by size, often small, medium, large or massive, and by how much the muscle has wasted or turned to fat. Those details strongly affect whether a repair is likely to heal.

Cuff changes are a normal part of aging. A pooled analysis of 30 studies found rotator cuff abnormalities in about 10% of people 20 and younger, rising to 62% of people 80 and older, including many with no symptoms at all.[9] So a tear on an MRI isn't automatically the cause of your pain.

Injury or wear? Why it matters

Traumatic tears happen with a fall or a sudden heavy pull, often in someone whose shoulder was fine before. Sudden weakness lifting the arm afterward is a warning sign. Many surgeons prefer to repair these relatively soon, before the tendon pulls back and the muscle weakens. A 2026 review found the evidence on timing is very weak, but recommended repairing traumatic tears as early as possible because waiting raises the risk that the tear can't be repaired.[15]

Degenerative tears develop slowly with age. Many people with these tears have little or no pain. When they do hurt, exercise-based treatment is usually tried first.

The trials that found little benefit from surgery mostly studied small, degenerative tears in people around 56 to 68 years old. Their conclusions may not apply to traumatic tears, large tears or younger people.[1]

Do you need surgery?

The case for trying therapy first

A Cochrane review of randomized trials found that, at one year, repair surgery probably gave little or no improvement in pain compared with exercise-based treatment, and may give only a small improvement in function. The authors rated the certainty as moderate to low and noted that no trial used a placebo surgery group.[1]

The case for repair

A Norwegian trial randomly assigned 103 people with tears up to 3 cm to repair or to physical therapy, with surgery later allowed if needed. At 10 years, the repair group had better scores for function, pain and pain-free motion, and the differences had grown since the earlier follow-ups. Fourteen people crossed over from therapy to surgery, and they did worse than those repaired first.[2]

A reasonable way to think about it

  • Tears from a clear injury, with real weakness, often lean toward early repair.
  • Small, wear-related tears with mainly pain often start with a few months of therapy.
  • Tears can grow. In a study following people with tears that weren't causing symptoms in one shoulder, about half of the tears got bigger over a median of 5 years, and tears that grew were more likely to start hurting.[10] Ask whether your tear should be re-checked with imaging if you go the non-surgical route.
  • Ask what would make your surgeon recommend surgery later, and whether your tear is likely to get bigger if left alone.

If your tear isn't full-thickness

Many people with shoulder pain have tendon irritation or a partial tear rather than a hole through the tendon. Two large UK trials are worth knowing about:

  • In the CSAW trial, decompression surgery (removing bone and tissue under the shoulder blade) for shoulder pain with intact tendons did no better than an arthroscopy where nothing was removed. Both surgery groups did only slightly better than no treatment, and not by a clinically important amount.[4]
  • In the GRASP trial of rotator cuff disorders, a six-session progressive exercise program was no better than a single session of good advice from a physiotherapist over 12 months, and a steroid injection gave no long-term benefit.[3]

That doesn't mean nothing works. It means many of these shoulders improve with time and simple, well-guided self-management, and that surgery for this kind of pain deserves careful questions.

What happens in surgery

Most repairs are done arthroscopically, through several small incisions with a camera, and most people go home the same day. A nerve block is often used to numb the arm for many hours afterward.

The surgeon cleans up the torn edge and the spot on the bone where the tendon attaches, then places small anchors in the bone. Sutures from the anchors are passed through the tendon to pull it back down and hold it while it heals.

Arthroscopic repair is now standard, but it isn't clearly better than open repair: in the UK's UKUFF trial, quality of life and costs were similar for the two approaches.[12]

Surgeons also choose how to fix the tendon: one row of anchors or two. A meta-analysis of 13 randomized trials found double-row repairs healed more often and re-tore less, though most function scores were similar.[14]

Some surgeons also shave the underside of the acromion (acromioplasty). A review of randomized trials found no difference in patient-reported outcomes or retear rates with or without it, though two studies saw fewer later reoperations when it was done.[6] Ask whether your surgeon plans it and why.

Healing and retears

The tendon has to grow back onto bone, and it doesn't always succeed. A meta-analysis of higher-quality studies found retear rates on imaging of about 15% at 3 months and 16 to 21% at later time points.[5]

Older age, larger tears and more fatty change in the muscle were linked with higher retear rates.[5] Smoking matters too: a meta-analysis of more than 73,000 patients found smokers had about twice the risk of retear and a higher risk of reoperation.[13] If you smoke, ask about quitting before surgery.

Platelet-rich plasma (PRP), made from your own blood, is sometimes added during repair. A meta-analysis of 18 randomized trials found PRP lowered the rate of incomplete tendon healing, while a related product, platelet-rich fibrin, did not help.[11] PRP is often not covered by insurance, so ask about cost.

A retear isn't always painful: some people with a retear on a scan still have a shoulder that works well.

Recovery, month by month

Protocols vary with tear size, tissue quality and surgeon preference. This is a common shape, not instructions.

  1. Weeks 0 to 6Arm in a sling most of the time, including sleeping. Gentle movement guided by your therapist. Many people sleep better propped up in a recliner at first.
  2. Weeks 6 to 12Out of the sling. Active movement begins, with the arm doing the work. No lifting or pushing yet.
  3. Months 3 to 6Strengthening starts. Most daily activities get easier through this window.
  4. Months 6 to 12Return to heavier work, overhead activity and sport, depending on the repair. Improvement can continue past a year.

When to start moving is debated. One meta-analysis of 13 trials found early motion improved range of motion without raising retear rates.[7] An earlier, smaller meta-analysis found delayed motion was linked with better tendon healing.[8] Your surgeon's timing will depend on your tear, so follow their plan.

Risks and complications

  • Retear or failure of the tendon to heal (see above).[5]
  • Stiffness, including frozen shoulder, which usually improves with time and therapy.
  • Persistent pain or weakness, especially with large tears or poor tendon quality.
  • Infection, nerve injury and blood clots, which are uncommon.

Questions to ask your surgeon

  1. Is my tear partial or full-thickness? How big is it, and how healthy does the muscle look?
  2. Do you think this came from an injury or from wear over time?
  3. What would happen if I tried therapy first? Could the tear get bigger while I wait?
  4. How likely is the tendon to heal in my case?
  5. Do you plan any other procedures, like acromioplasty or biceps surgery? Why?
  6. How long will I be in a sling, and when can I drive and return to work?
  7. What does your rehab plan look like, and when do I start moving the arm?

Recovery supplies

We're putting together vetted picks at a range of prices. Until then, these are the categories people most often need:

  • Cold therapy (ice packs or a shoulder cold unit)
  • Wedge pillow or recliner
  • Button-front and loose shirts
  • Slip-on shoes
  • Long-handled sponge
  • Pump soap and dispensers
  • Small pillow for under the sling
  • Resistance bands (for later)

Your surgeon will usually provide the sling. Check before buying a cold therapy unit, since some practices supply one.

Sources

  1. Karjalainen TV, et al. Surgery for rotator cuff tears. Cochrane Database Syst Rev. 2019;12:CD013502. https://doi.org/10.1002/14651858.CD013502
  2. Moosmayer S, et al. At a 10-year follow-up, tendon repair is superior to physiotherapy in the treatment of small and medium-sized rotator cuff tears. J Bone Joint Surg Am. 2019;101:1050-60. https://doi.org/10.2106/JBJS.18.01373
  3. Hopewell S, et al. Progressive exercise compared with best practice advice, with or without corticosteroid injection, for rotator cuff disorders (GRASP): a randomised controlled trial. Lancet. 2021;398:416-28. https://doi.org/10.1016/S0140-6736(21)00846-1
  4. Beard DJ, et al. Arthroscopic subacromial decompression for subacromial shoulder pain (CSAW): a placebo-controlled, randomised surgical trial. Lancet. 2018;391:329-38. https://doi.org/10.1016/S0140-6736(17)32457-1
  5. Longo UG, et al. Retear rates after rotator cuff surgery: a systematic review and meta-analysis. BMC Musculoskelet Disord. 2021;22:749. https://doi.org/10.1186/s12891-021-04634-6
  6. Maguire JA, et al. Rotator cuff repair with or without acromioplasty: a systematic review of randomized controlled trials. Am J Sports Med. 2024;52:3404-11. https://doi.org/10.1177/03635465231213009
  7. Hu CW, et al. Early versus delayed mobilization for arthroscopic rotator cuff repair: a meta-analysis of randomized controlled trials. BMC Musculoskelet Disord. 2023;24:938. https://doi.org/10.1186/s12891-023-07075-5
  8. Chen L, et al. Rehabilitation protocol after arthroscopic rotator cuff repair: early versus delayed motion. Int J Clin Exp Med. 2015;8:8329-38. https://pmc.ncbi.nlm.nih.gov/articles/PMC4538011/
  9. Teunis T, et al. A systematic review and pooled analysis of the prevalence of rotator cuff disease with increasing age. J Shoulder Elbow Surg. 2014;23:1913-21. https://doi.org/10.1016/j.jse.2014.08.001
  10. Keener JD, et al. A prospective evaluation of survivorship of asymptomatic degenerative rotator cuff tears. J Bone Joint Surg Am. 2015;97:89-98. https://doi.org/10.2106/JBJS.N.00099
  11. Hurley ET, et al. The efficacy of platelet-rich plasma and platelet-rich fibrin in arthroscopic rotator cuff repair: a meta-analysis of randomized controlled trials. Am J Sports Med. 2019;47:753-61. https://doi.org/10.1177/0363546517751397
  12. Murphy J, et al. Costs, quality of life and cost-effectiveness of arthroscopic and open repair for rotator cuff tears: an economic evaluation alongside the UKUFF trial. Bone Joint J. 2016;98-B:1648-55. https://doi.org/10.1302/0301-620X.98B12.BJJ-2016-0121.R1
  13. Fan N, et al. The effects of smoking on clinical and structural outcomes after rotator cuff repair: a systematic review and meta-analysis. J Shoulder Elbow Surg. 2022;31:656-67. https://doi.org/10.1016/j.jse.2021.10.026
  14. Núñez JH, et al. Arthroscopic rotator cuff repair using a single or double row technique: a meta-analysis of randomized clinical trials. Rev Esp Cir Ortop Traumatol. 2025;69:659-69. https://doi.org/10.1016/j.recot.2023.11.023
  15. Lara PHS, et al. Evidence-based reviews and recommendations from the Brazilian Society of Shoulder and Elbow Surgery: early versus late repair for traumatic rotator cuff tears. Acta Ortop Bras. 2026;34:e308952. https://doi.org/10.1590/1413-785220263401e308952

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