Trephination in Arthroscopic Cuff Repair: a Prospective Randomized Controlled

Inclusion Criteria: 1. Patients who have failed standard non-surgical management of their rotator cuff tear, and who would benefit from a surgical repair of the cuff. Failed medical management will be defined as persistent pain and disability despite adequate standard non-operative management for 6 months. Medical management will be defined as: 1. The use of drugs including analgesics and non-steroidal anti-inflammatory drugs 2. Physiotherapy consisting of stretching, strengthening and local modalities (ultrasound, cryotherapy, etc) 3. Activity modification 2. Imaging, and intra-operative findings confirming a full thickness tear of the rotator cuff. Exclusion Criteria: 1. Characteristics of the cuff tear that render the cuff irrepairable: fatty infiltration in the muscles grade III (50%) or greater; superior subluxation of the humeral head; retraction of the cuff to the level of the glenoid rim. 2. Partial thickness cuff tears. 3. Significant shoulder comorbidities e.g. Bankart lesion, osteoarthritis 4. Previous surgery on affected shoulder e.g. Previous rotator cuff repair. 5. Isolated subscapularis tendon tears 6. Active joint or systemic infection 7. Significant muscle paralysis 8. Rotator cuff tear arthropathy 9. Charcot's arthropathy 10. Significant medical comorbidity that could alter the effectiveness of the surgical intervention (eg. Cervical radiculopathy, polymyalgia rheumatica) 11. Major medical illness (life expectancy less then 1 year or unacceptably high operative risk) 12. Unable to speak or read English/French 13. Psychiatric illness that precludes informed consent 14. Unwilling to be followed for 24 months 15. Advanced physiologic age