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A common question is should a bad shoulder be operated on or not. Actually, it is not a relevant question. The aim in treating shoulder problems is to heal the shoulder. Operative or non-operative treatments are not equal alternatives. If a shoulder problem can be treated conservatively, it should always be the first alternative. On the other hand, sometimes the shoulder may need operative treatment to heal. The patient is the doctor’s client and the best solution to the problem is being aware of the patient’s interests. The needs of a top athlete are clearly different from that of a 50–year-old.

There are always pros and cons to operative treatment. It may be the way to get the shoulder back in competitive shape. However, every operation includes risks. Of the risks related to operative treatment, infection is the worst. Most often it is unexpected and may lead to the destruction of the surgical reconstruction. The reaction of the patient’s tissue may sometimes be adverse and cause delayed healing.

In arthroscopic reconstructive surgery, there are no spare parts. The surgeon has to manage with the tissue quality available. Sometimes it resembles “mending an old sock”. The only true spare parts are related to replacement surgery (prosthesis), and at that point we are not talking about sports surgery any more. In terms of surgery, not only is it about good surgical techniques, but nature’s contribution as well. Otherwise, healing will not take place. For this reason, the outcome may not always be perfect, but good enough. The main goal in old, chronic rotator cuff-tears, especially, is to get rid of pain and then get the arm to move better and restore strength.

In operative treatment, the best possible outcome is achieved when technique and experience are solid, and the latest equipment available. Most patients receive an excellent outcome from surgical treatment, when indications are sound and right things are done for a specific problem.