Rotator Cuff Repair Step by Step: How I Reattach the Torn Tendon

Medically reviewed by M. Brett Raynor, M.D., board-certified orthopaedic sports medicine surgeon. Updated October 2026.

This animation shows how I repair a torn rotator cuff. When the tendon tears away from the bone, it usually can't heal back down on its own, so if it keeps on hurting, surgery puts it back where it belongs and holds it there so it can heal. Through a camera and four or five small poke holes, I look at everything inside the joint, then do a biceps tenodesis: I release the biceps tendon from the top of the socket and reattach it to the arm bone so it no longer pistons in and out of its groove. For the repair, I roughen the bone, place small anchors at the edge of the joint, pass their sutures through the tendon, tie a stitch at the front and the back, and crisscross the tapes into a second row of anchors that press the tendon flat against the bone.

 

In this video

  • 0:00 The shoulder and the rotator cuff
  • 0:19 The biceps tendon
  • 0:30 When the tendon tears
  • 0:42 Small incisions and a look inside
  • 0:57 Biceps tenodesis
  • 1:30 Roughening the bone and placing the anchors
  • 1:45 Passing the sutures through the tendon
  • 2:23 Tying and crisscrossing the sutures
  • 2:43 Shaving down the bone spur
  • 2:54 The finished repair and closing the incisions
  • 3:16 After surgery: the sling and recovery

Common questions

Why doesn't a torn rotator cuff heal on its own?

When the tendon tears away from the bone, it usually can't heal back down on its own. If it keeps on hurting, surgery puts it back where it belongs and holds it there so it can heal.

What is a biceps tenodesis, and why do it during a rotator cuff repair?

One of the biceps tendons makes a 90-degree turn through a tight little sheath into the shoulder, and that spot can hurt too, especially next to a tear. I lasso the tendon with a stitch, release it from the top of the socket so it no longer crosses the joint, and reattach it to the arm bone, so it doesn't piston in and out of its groove anymore. It doesn't usually change your recovery, and it keeps the muscle from balling up.

How is the tendon held back on the bone?

I roughen the bone so the tendon has a fresh surface to heal to, then place two small anchors, sometimes more for bigger tears, right at the edge of the joint. Their sutures are passed through the tendon, tied at the front and the back to hold the edge down, and crisscrossed into a second row of anchors, which compresses the tendon flat against the bone so it can heal.

Why shave down the bone spur?

At the end I shave down the bone spur at the top of the tendon so it has more room to move and doesn't get rubbed on.

How long is recovery after rotator cuff repair?

You'll be in a sling for six weeks. The tendon is healed at about four months, most people are doing what they want by six months, and it takes about a year before you stop thinking about your shoulder.

Full transcript

The shoulder is a ball and socket joint. The rotator cuff are four tendons, deep down inside, that help initiate motion. There's one up top, one in the front, and two around the back. One of your biceps tendons comes up and makes a 90-degree turn through a tight little sheath into the shoulder. That spot can hurt too, especially next to a tear. When the tendon tears away from the bone, it usually can't heal back down on its own, and if it keeps on hurting, surgery is performed to put it back where it belongs and hold it there so it can heal. I do this through a camera, usually through four or sometimes five little poke holes. First I look at everything inside the joint: the biceps, the socket and its rim, called the labrum, and the ball. Anything frayed gets cleaned up with a shaver. Normally I'll also do something to your biceps so it doesn't keep hurting you afterwards. Usually that's called a biceps tenodesis, where I lasso it with a stitch and cinch it down, and then I put another stitch so it can't roll off. Then I release it from the top of the socket so it no longer crosses the joint, and reattach it here onto the humerus so it doesn't have to piston in and out of that groove anymore, which decreases the pain. It doesn't usually change your recovery, and it keeps the muscle from balling up like Popeye when we reattach it like this. Then, to fix the rotator cuff, I roughed up the bone so the tendon has a fresh surface to heal to. Next, two small anchors, sometimes more for bigger tears, go into the bone right at the edge of the joint. One at a time, I grab each suture and bring it out through a small clear tube called a cannula. A passer then bites through the tendon and fires the suture up through it, bringing the suture through the tendon to help repair it. Then I bring it out a cannula in the front, out of the way. Same for every suture from the front anchor. Then the back anchor goes in, and its sutures come up through the tendon the same way and out of the tube in the back. Then I tie a stitch at the front and one at the back to hold the edge of the tendon down, reducing the tendon where it's supposed to go. Then I crisscross the sutures and tapes over the top and dunk them into another set of anchors laterally. This compresses the tendon against the roughened surface of the bone and holds it flat against the bone so it can heal. Lastly, I shave down a bone spur at the top of the tendon so it has more room to move and doesn't get rubbed on. Now the tendon sits right back where it came from, and it moves with the bone as one piece. At the end, each poke hole is closed using a single stitch.

Related

This video and page are general education and are not a substitute for an evaluation of your own knee, shoulder or hip.

Make An Appointment