Operative treatment of failed repairs of the rotator cuff.

Thirty-one patients had a repeat repair after a failure of a previously performed repair of the rotator cuff, and the causes of the original failure and the results of the repeat repair were analyzed. The clinical situation was complex, with multiple factors contributing to the failures. A large or massive tear of the cuff in thirty patients (97 per cent) and persistent subacromial impingement in twenty-eight patients (90 per cent) were the most common factors associated with failure. The over-all result of the repeat repair was satisfactory in sixteen patients (52 per cent) and unsatisfactory in fifteen (48 per cent). Twenty-five patients (81 per cent) had satisfactory relief of pain. However, fourteen patients (45 per cent) had persistent weakness that led to an unsatisfactory result. The factors that were associated with a better result were an intact acromion, an intact origin of the deltoid muscle, and the finding that the remaining tissue of the rotator cuff was of good quality. The factors that were associated with an inferior result were a previous lateral acromionectomy, a previously detached origin of the deltoid muscle, and the finding that the tissue of the rotator cuff that was available at the time of the repeat operation was of poor quality. Persistent pain is the primary indication for a repeat repair. The functional results are not as predictable, especially when the tissue of the cuff is poor and the deltoid origin has been detached previously.