Failed Rotator Cuff Repair

As the population ages and the volume of rotator cuff repairs performed increases, there has been a growth in the number of failed rotator cuff repair cases. While some patients may have no clinically relevant findings following a failed or retear of their rotator cuff, others experience significant pain and functional limitations of their shoulder. Methods of failure include a traumatic event leading to a retear, biologic factors, and technical factors related to primary repair itself. The risk of retear and failure is significantly associated with increased age, larger tear size, fatty infiltration, muscle tendon unit retraction, the presence of multiple comorbidities, and also surgeon’s technique. Conservative treatment is suitable for patients with minimal symptoms of retear or failure; however, for those patients with continued symptoms following failed rotator cuff repair, surgical management may be required especially if pain and functional deficits are severe. Surgical options include revision of the repair site, augmentation with a patch or implant, superior capsular reconstruction, tendon transfer, or reverse total shoulder arthroplasty. Although not all rotator cuff repair failures or retears can be prevented, surgeons should employ prevention strategies including nutritional assessment and supplementation, releases to ensure tension free suture fixation, marrow access via microfracture and vented anchors, and tendon augmentation when indicated. Postoperative rehabilitation should be focused on giving the tendon adequate time to heal, and early, and aggressive physical therapy should be avoided in patients with a revision rotator cuff repair to give the tendon adequate time for healing. Most patients with a revision repair report a significant improvement in pain and functional capabilities although the risk of retear is higher after a revision procedure.