The rotator cuff consists of four muscles and their tendons surrounding the shoulder joint, providing stability and a wide range of motion. Injuries to these tendons, often due to trauma or chronic wear, are a common orthopedic issue resulting in pain and weakness. While minor tears can be managed without surgery, a large or full-thickness tear often requires surgical repair to reattach the tendon to the upper arm bone (humerus). The time a patient spends in the operating room is highly variable, depending on the specific surgical approach and the complexity of the injury.
Duration of the Rotator Cuff Repair Procedure
The time spent under anesthesia while the surgeon actively repairs the torn tendon, known as the operative time, typically ranges from 60 to 120 minutes. This duration represents only the core procedure and excludes the considerable time spent in preparation and recovery. The specific surgical technique chosen by the orthopedic surgeon is the greatest determinant of the procedure’s length.
Most modern repairs use an arthroscopic technique, a minimally invasive method involving a small camera and specialized instruments inserted through tiny incisions. This approach is associated with shorter operative times, often averaging 60 to 90 minutes for a standard repair. Less complex, smaller repairs performed by experienced surgeons have even reported average operative times closer to 20 to 35 minutes.
In contrast, an open repair requires a larger incision and involves detaching and reattaching a portion of the deltoid muscle. This technique typically takes longer, sometimes ranging from 90 to 120 minutes or more. Open repair is less common today, often reserved for massive tears, complex reconstructions, or cases requiring revision surgery.
Key Variables Affecting Operating Time
The inherent characteristics of the tear itself significantly influence the operative time, moving the procedure toward the shorter or longer end of the average range. The size and severity of the tendon tear are primary factors, as a small, partial-thickness tear requires less fixation and manipulation than a large or massive full-thickness tear. Repairing a massive tear, especially one that has retracted far from the bone, involves more time-consuming maneuvers to mobilize the tissue and secure it back to the humerus.
The quality of the tendon tissue is another major variable, as chronic tears often result in poor tissue quality or retraction, making the repair more technically demanding and slower. Furthermore, the need for concomitant procedures adds directly to the operative duration. It is common for the surgeon to address associated issues such as removing bone spurs (acromioplasty), treating a damaged biceps tendon (biceps tenodesis), or excising the end of the clavicle (distal clavicle excision).
The specific repair technique chosen also impacts the duration, such as whether a single-row or a more complex transosseous-equivalent dual-row fixation method is used. The dual-row technique, which uses more anchors to create a broader compression zone, typically requires a longer operative time than the single-row method. Finally, the experience level of the surgical team and the efficiency of the operating room staff can play a role, with more experienced surgeons often performing the repair more quickly and efficiently.
The Complete Surgical Day Timeline
While the operative time is typically one to two hours, the patient’s complete timeline within the surgical facility is significantly longer, generally spanning four to eight hours from arrival to discharge. This entire process is often more relevant to the patient’s planning than the surgical duration alone. The day begins with the pre-operative phase, which can take two to three hours.
During the initial pre-operative time, the patient completes registration, changes into a gown, and undergoes a detailed nursing assessment. A substantial portion of this phase involves meeting with the anesthesiologist to discuss the anesthesia plan, which frequently includes administering a regional nerve block for pain control that lasts well into the post-operative period. The surgical site is also marked by the surgeon to confirm the correct location before the patient is moved into the operating room.
Once the repair procedure is complete, the patient is transferred to the Post-Anesthesia Care Unit (PACU) for monitoring, a phase that usually lasts one to two hours. In the PACU, the medical team closely monitors the patient’s vital signs, manages any initial post-operative pain, and waits for the effects of the general anesthesia to begin wearing off. The patient must be fully awake and stable before moving on to the final discharge area.
The final stage is the discharge phase, which is when the patient is moved to a recovery room to prepare for going home. For an outpatient procedure, discharge criteria must be met, including adequate pain control, the ability to tolerate clear fluids, and stable vital signs. The patient and their accompanying support person receive detailed instructions on wound care, medication use, and the initial rehabilitation protocol before being cleared to leave the facility. The total time spent in the facility is most often dictated by how quickly the patient recovers from anesthesia and how effectively their pain is controlled before safe discharge is possible.