Rotator Cuff Repair and Patch Augmentation

A single ligament reconstruction, ACL or PCL, costs approximately $4,000 to $4,500, all-inclusive from admission to discharge. Meniscal debridement alone is $2,500 to $3,000, and meniscal repair ranges from $4,000 to $5,000 depending on the number of suture anchors used, at roughly $500 each. A simple Bankart repair for shoulder instability costs $4,000 to $5,000, with remplissage adding about $1,000. PRP injections without surgery run about $500 per injection, with 3 to 4 injections typically needed over roughly six weeks.

Ligament reconstruction, ACL or PCL, has a 98 to 99% success rate, with failures very rarely seen. Meniscal repair success depends on how much of the meniscus is torn and how early the patient presents, but even large tears repaired a year after injury succeed around 90 to 95% of the time. Shoulder stabilisation surgery, Bankart repair or Latarjet, is 95 to 98% successful when planned correctly, and rotator cuff repair succeeds 90 to 95% of the time.

Blood supply to the meniscus runs from outside to inside, dividing it into three zones. The outer red-red zone near the capsule has decent blood supply, which is why peripheral tears heal well. The middle red-white zone has moderate blood supply and can still be repaired if augmented with orthobiologics. The innermost white-white zone has very poor blood supply, and a peripheral rim tear there is better debrided than repaired with multiple anchors into non-vascular tissue.

The meniscus is the only shock absorber between the femur and the tibia, taking on all the compressive and shear stress of walking, running and sport, and preventing the two bones' cartilage from grinding directly against each other. Once it is removed, that cartilage-on-cartilage contact leads to arthritis within a few years. A patient can function without an ACL, but without a meniscus, arthritis is inevitable.

Not at all, this is a different situation from minimally invasive spine or brain surgery. Arthroscopy actually gives a clearer view of the joint than open surgery would; even opening the knee completely to repair the posterior horn of the meniscus does not give as clear a view as the arthroscope does. In twenty years of practice, an arthroscopy has never needed conversion to an open procedure, provided the surgeon is patient and knows the anatomy well.

The tendon end has poor intrinsic blood supply, which is why rotator cuff tears do not heal spontaneously and generally require surgical repair.

It is used when tendon quality is poor, when the tear is very large or massive involving multiple rotator cuff tendons, when suture anchors alone cannot be relied on, or in revision surgery where poor tendon quality caused the original repair to fail.