Reoperation for failed rotator cuff repair: Analysis of fifty cases.

Fifty patients who underwent reoperation for failure of previous repair of rotator cuff rupture were evaluated 24 to 84 months after final repair (mean 30 months). Forty-eight of these patients had undergone all previous attempts at repair elsewhere. Most patients had had one or two earlier attempts, but four patients had had three, and three patients had had four. Forty-six (92%) patients reported pain improvement, and four were unchanged. Twenty-six patients showed an average increase in elevation of 50° (range 10° to 130°). Twenty-two retained their preoperative motion, and two lost motion (mean 45°) but still had more than 90°. Overall mean elevation increased from 92° to 137°. Compared with 17 patients before surgery, only six had less than 90° motion after surgery-and all six had deltoid abnormalities. The size of the rupture, the number of previous operations, and dysfunction of the biceps did not affect the result. The following factors were associated with success: adequate decompression, closure of all defects with tendon-to-bone junctures (by direct repair, interpositional grafting, or local tendon transfers), avoiding use of weights or resistive exercises during the early (first 3 months) postoperative rehabilitation period, and an intact, functioning deltoid.