Failed rotator cuff surgery, evaluation and decision making.

Rotator cuff repair is very likely to be clinically successful when performed well and rehabilitated properly, especially when judged with patient satisfaction outcome scores. A healed rotator cuff tendon will likely result in an improved and lasting clinical result. Recurrent tears will still be present despite optimal mobilization and fixation of the rotator cuff to bone, especially in large tears with retraction and atrophy. Failure of rotator cuff repairs is multifactorial with biologic factors, such as age, tear size, and fatty infiltration probably most critical. Other patient-related factors (ie, diabetes, smoking), recurrent trauma, and technical error at the time of surgery also contribute to rotator cuff repair failure. When managing a patient with a symptomatic re-tear, revision rotator cuff repair can be a very successful procedure, but patient selection is critical and managing patient expectations is paramount. Ideal candidates for revision rotator cuff repair have minimal muscle atrophy, minimal tendon retracted, preoperative forward elevation of greater than 90°, a functioning deltoid, and no evidence of cuff tear arthropathy.