York, ME (207) 363 3490 | Portsmouth, NH (603) 431 1121

20Hip Care
10Hip-Conditions and Injuries
Cartilage Injury
Femoroacetabular Impingement (FAI)
Gluteal Tears
Hamstring Tears
Hip Instability
Deep Gluteal Space Syndrome
Labral Tears
Psoas Impingement (Internal Snapping Hip)
Trochanteric Bursitis
10Hip-Treatment and Surgeries
Gluteal Repair
Labral Debridement
Labral Reconstruction
Labral Repair
Psoas Release
Trochanteric Bursa Debridement
33Knee Care
13Knee Conditions and Injuries
ACL Tear
Cartilage Injury
Discoid Meniscus
Lateral Meniscus Tear
LCL Injury
MCL Injury
Medial Meniscus Tear
Osteochondritis Dessicans
Patellar Instability
Patellofemoral Chondromalacia
Posterolateral Corner Injury
Trochlear Dysplasia
20Knee Treatment and Surgeries
Anterior Cruciate Ligament (ACL) Reconstruction
Cartilage Restoration Surgery – Autologous Chondrocyte Implantation (ACI-Carticel)
Cartilage Restoration Surgery – Donor Graft
Collagen Meniscal Implant (CMI)
Lateral Collateral Ligament (LCL) Reconstruction
Medial Collateral Ligament (MCL) Reconstruction
Meniscus Repair
Meniscus Root Repair
Meniscal Transplant
Medial Patellofemoral Ligament (MPFL) Reconstruction
Osteochondral Allograft Transfer
Osteochondral Autograft Transfer (OATS)
Partial Knee Replacement (MAKO)
Partial Meniscectomy
Posterior Cruciate Ligament (PCL) Reconstruction
Posterolateral Corner (PLC) Surgery
Tibial Tubercle Osteotomy
Total Knee Replacement (MAKO)
20Shoulder Care
10Shoulder-Conditions and Injuries
AC Joint Injuries
Biceps Tendon Injuries
Calcific Tendinitis
Clavicle Fractures
Frozen Shoulder
Labral and SLAP Tears
Rotator Cuff Injuries
Shoulder Dislocation/Instability
Subacromial Impingement/Busitis
10Shoulder-Treatment and Surgeries
A-C Joint Stabilization
Biceps Tenodesis
Clavicle Fracture Fixation
Pectoralis Major Repair
Rotator Cuff Repair
Shoulder Instability Surgery – Bankart Repair
Shoulder Instability Surgery – Latarjet Procedure
Subacromial Decompression and Acromioplasty
Superior Capsular Reconstruction
Total Shoulder Replacement


The rotator cuff is a group for muscles that surround the shoulder and play a primary role in keeping the proximal humerus (ball) centered within the socket (glenoid) of the shoulder joint. The rotator cuff tendons also enable one to lift his/her arm and rotate his/her arm with strength. Rotator cuff tears are classified into partial-thickness and full-thickness tears. In partial-thickness tears, part of the torn rotator cuff tendon is still attached to the humerus bone. In full-thickness tears, the entire tendon is torn off of the bone.

During surgery, Dr. Welch restores the torn part of the rotator cuff back to its normal position on the humerus bone. There are many different techniques to achieve this goal. Dr. Welch uses a minimally-invasive, arthroscopic technique with either a “single-row” or a “double-row” repair configuration. A single row repair is best for partial-thickness tears or for smaller full-thickness tears. During a single row repair, Dr. Welch places one or two suture anchors (medical screws) in the appropriate position on the humerus bone. He then passes very strong sutures that are connected to the anchors through the rotator cuff tendon and ties strong knots to stabilize the torn tendon back down to the bone.

Dr. Welch recommends a double-row technique for larger rotator cuff tears or tears involving more than one tendon. In a double row technique, Dr. Welch places two or three additional suture anchors adjacent to the single row anchors. After passing the sutures and tying knots from the original row of anchors, Dr. Welch passes the suture limbs over the top of edge of the torn rotator cuff tendon and then tensions down the suture limbs through the second row of anchors. This technique enables to Dr. Welch to compress more healthy tissue down to the bony “footprint.” This double-row technique enables Dr. Welch to expand the surface area of tissue compressed to bone so that the tissue has a better chance to heal. Numerous basic science studies have demonstrated that a double row technique leads to a higher rate of healing of tendon back to the humerus bone when compared to a single row technique.

Post-Operative Rehabilitation

Following surgery, patients are placed in a sling with a pillow. The pillow positions the arm away from the chest and keeps tension off of the repaired rotator cuff tissue. Dr. Welch recommends intermittent icing and gentle range of motion following surgery. Dr. Welch recommends starting physical therapy 2-6 weeks after surgery, depending on the size of the tear and type of repair. Physical therapy focuses on reducing swelling in the shoulder, restoring full range of motion, and eventually, restoring strength to the shoulder. Proper rehabilitation following rotator cuff repair is a steady, sometimes tedious process. It is very important to follow the rehabilitation process carefully to achieve the best outcome.