Which Specialist Performs Arthroscopic Tendon Repair
Orthopedic surgeons perform arthroscopic tendon repair, with referral warranted when conservative treatment fails to resolve persistent pain. 1
Primary Specialist
- Orthopedic surgeons are the specialists who perform arthroscopic tendon repair procedures 1
- Referral to an orthopedic surgeon for surgical evaluation is appropriate when pain persists despite a well-managed conservative treatment trial 1
Subspecialty Training Considerations
While general orthopedic surgeons can perform these procedures, fellowship training significantly impacts outcomes:
For Rotator Cuff Repairs Specifically:
- Shoulder and Elbow fellowship-trained surgeons demonstrate the lowest overall complication rates at 90 days, 1 year, and 5 years postoperatively 2
- Sports Medicine fellowship-trained surgeons also show significantly lower complication rates compared to surgeons with other fellowship training or no fellowship 2
- Both Shoulder/Elbow and Sports Medicine surgeons are performing an increasing proportion of shoulder arthroscopy procedures over time 2
- Individual complication rates between Sports Medicine and Shoulder/Elbow trained surgeons are comparable, though Shoulder/Elbow surgeons have the lowest pooled complication rates overall 2
Technical Expertise Requirements:
- Arthroscopic rotator cuff repair requires significant technical skill and experience 3
- Surgeon experience directly correlates with outcomes—retear rates significantly decrease after approximately 97 cases, with small to medium tears showing dramatic improvement (26% to 2% retear rate) as surgeons gain experience 4
- Experienced arthroscopic surgeons report results equal to open rotator cuff repair 3
Clinical Pathway for Referral
When to refer to orthopedic surgery:
- Conservative management (rest, physical therapy, NSAIDs, activity modification) has been attempted for an appropriate duration without adequate pain relief 1
- Surgical techniques typically include excision of abnormal tendon tissue and longitudinal tenotomies to release scarring and fibrosis 1
Important Caveats
- The American Academy of Orthopaedic Surgeons cannot recommend for or against a specific surgical technique (arthroscopic vs. mini-open vs. open repair) based on current evidence 5
- However, arthroscopic techniques have evolved to repair all patterns and sizes of rotator cuff tears, including massive tears 3
- Simpler arthroscopic procedures (irrigation, trimming, loose body removal) have excellent results, while more complex repairs require greater technical expertise 6