Rotator cuff repair is surgery to repair a torn tendon in the shoulder. The procedure can be done with a large (open) incision or with shoulder arthroscopy, which uses small buttonhole-sized incisions.
Surgery to repair a torn rotator cuff tendon usually involves:
- Removing loose fragments of tendon, bursa, and other debris from the space in the shoulder.
- Shaving bone or removing bone spurs from the point of the shoulder blade (subacromial smoothing).
- Sewing the torn edges of the supraspinatus tendon together and to the top of the upper arm bone (humerus).
Arthroscopic surgery is the most common way. But in some cases, the surgeon needs to do open-shoulder surgery, which requires a larger incision.
The physician performs an open repair of a ruptured rotator cuff by first making an incision over the shoulder joint to expose the rotator cuff.
The underside of the acromion is inspected, smoothed, and flattened as needed using a motorised burr and shaver. The rotator cuff is visualised and the size and pattern of the tear is evaluated. Thin or fragmented portions of the rotator cuff are removed.
If the defect is repaired by direct tendon to tendon repair, the proximal and distal portions of the ruptured tendon are sutured together. Large defects may require tendon mobilization or advancement of tendon flaps.
If a tendon to bone repair is required, the site where the rotator cuff will be reattached to bone is debrided. A Side-to-side stitches may be used to initiate closure of a large rotator cuff defect.
Sutures are passed through the tendon ends and secured. Metallic anchors with sutures are then placed in the humerus at the site where the tendon will be reattached. The sutures are passed through the tendon and tied, pulling the tendon down to the prepared bone surface. When the procedure is complete, the incision is closed and a dressing is applied.
CPT Codes & Guideline
23410 Repair of musculotendinous cuff, acute
23412 Repair of musculotendinous cuff, chronic
23420 Reconstruction of complete shoulder [rotator] cuff avulsion, chronic (includes acromioplasty)
Code 23410 use for young patients who have an acute episode resulting in a torn rotator cuff and early repair.
Code 23412 is more appropriately used for most of the rotator cuff tears that occur in older individuals who have sustained a tear over time, with or without a superimposed acute episode.
Code 23420 is more frequently use in retraction with a large tear, extensive releases and mobilization. If fascia or synthetic material is used, code 23420 also is appropriate.
If a tendon transfer was performed, code 23397-59 would be used in with code 23420.
Code 29827 (Arthroscopy, shoulder, surgical, with rotator cuff repair) is used for arthroscopy. It is must to repair at least two of the rotator cuff muscle including glenoid rim etc
If arthroscopic subacromial decompression with or without acromioplasty and/or coracoacromial ligament release also is performed, code 29826-51 is appropriate. If arthroscopic subacromial decompression is done, followed by an open or mini-open rotator cuff repair, the coding sequence should be 23410 or 23412 and 29826-59.
An open reconstruction of the shoulder joint may be done as
- a hemiarthroplasty, CPT code 23470,
- a total shoulder replacement, CPT code 23472.
A hemi-arthroplasty of the glenohumeral joint involves placement of a prosthetic humeral head, while a total shoulder arthroplasty involves prosthetic replacement of both the glenoid and the humeral head.