Evaluation and management of failed rotator cuff repairs.

Revision rotator cuff reconstruction should be based on the clinical problem, not the mere presence of a cuff defect. A functional deltoid is critical to the success of such surgery. Reconstructive procedures on the cuff include direct repair, interpositional grafting, and tendon transfers associated with an appropriate decompression. Decompression without repair-merely de bridement of the cuff-carries a significant risk of creating a severe functional loss and a poor outcome.