This review examines the causes, evaluation, and treatment of failed rotator cuff repair. It covers the intrinsic and extrinsic factors driving structural failure and when revision is warranted. It details an arthroscopic revision technique and summarizes reported outcomes.
65 years: 43%
The decision rule to carry into clinic: a recurrent tear on imaging is not itself a reason to reoperate. Many patients heal partially and keep functional gains, so revision is for persistent disabling pain and weakness at 9 to 12 months once infection, cervical pathology, and advanced cuff arthropathy are excluded.
When you counsel a patient, the numbers that matter are age, tear size, and Goutallier grade. Healing falls to 43% over age 65, multiple-tendon tears fail nearly 9× more often, and grade 4 fatty degeneration limits improvement to 40%. For patients over 70 with grade 4 degeneration and severe dysfunction, reverse total shoulder is the more predictable option.
Technically, repair the subscapularis first. The comma sign links it to the supraspinatus, so restoring it reduces anterior supraspinatus tension and rebalances the force couples that drive a successful repair.
This review examines the causes, evaluation, and treatment of failed rotator cuff repair. It covers the intrinsic and extrinsic factors driving structural failure and when revision is warranted. It details an arthroscopic revision technique and summarizes reported outcomes.
65 years: 43%
The decision rule to carry into clinic: a recurrent tear on imaging is not itself a reason to reoperate. Many patients heal partially and keep functional gains, so revision is for persistent disabling pain and weakness at 9 to 12 months once infection, cervical pathology, and advanced cuff arthropathy are excluded.
When you counsel a patient, the numbers that matter are age, tear size, and Goutallier grade. Healing falls to 43% over age 65, multiple-tendon tears fail nearly 9× more often, and grade 4 fatty degeneration limits improvement to 40%. For patients over 70 with grade 4 degeneration and severe dysfunction, reverse total shoulder is the more predictable option.
Technically, repair the subscapularis first. The comma sign links it to the supraspinatus, so restoring it reduces anterior supraspinatus tension and rebalances the force couples that drive a successful repair.