Q: My sister had a rotator cuff repair 10 years ago and had a rough time of it. The tear reopened after surgery and she ended up having two more operations. Now I find myself in the same position of needing rotator cuff surgery. Is there any chance things are better now that another decade has passed -- maybe safer, better ways of doing the operation? I definitely don't want to go through what she has.Surgery for the shoulder has changed over the years. A wide incision and open surgery has given way now to minimally invasive procedures using arthroscopic techniques. Arthroscopic approaches can be all-arthroscopic or arthroscopic combined with a small incision called mini-open. A: Even the type of sutures used has evolved from single-row repairs to double-row stitches. Among suture techniques there's the transosseous, single-row suture anchor, combined transosseous/suture anchor, double-row suture anchor, and suture bridge to choose from. Some of these techniques were first introduced and studied just in the last 5 years.Surgeons have found that the repair method affects the structural healing rate. In a systematic review of 23 studies where MRIs were used to see how well the healing was coming along, patients repaired with the double-row technique had the best results with the lowest rate of retears. It seems the double-row suture improves the biomechanical performance and contact area and pressure of the healing tissue. The double-row technique also applies less tension to the healing tissue, which is important during the rehab phase after surgery.Experienced surgeons get the most consistent results. In the case of double-row sutures, the technique requires more extensive releases of the surrounding soft tissue. Getting the right tension on the healing tissue can be a fine art. There is evidence that selecting a surgeon who has done a large number of these procedures in a hospital that also reports a high volume of surgeries yields the best overall results.Reference: Thomas R. Duquin, MD, et al. Which Method of Rotator Cuff Repair Leads to the Highest Rate of Structural Healing. A Systematic Review. In The American Journal of Sports Medicine. April 2010. Vol. 38. No. 4. Pp. 835-841.