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Revision rotator cuff repair

40 citationsUpdated Aug 2026

For patients: a plain-language version of this topic is available. See the patient guide.

Overview

Revision rotator cuff repair is indicated for patients who persist with clinical symptoms despite nonsurgical management, provided there are no substantial risk factors for failure [2]. While outcomes are inferior to those of primary repair [1], the procedure yields significant improvements in both pain and function at 5 years postoperation [3]. Long-term follow-up (minimum 10 years) confirms sustained pain relief and functional score improvement [6]. Arthroscopic revision repair offers a reasonable treatment option even after prior open repairs, delivering improved pain relief and shoulder function [7]. Notably, arthroscopic revision can lead to improved functional outcomes despite a high retear rate [4].

The complication rate after arthroscopic revision rotator cuff repair is approximately twice the published rate for primary rotator cuff repair [16]. To mitigate this risk, performing concurrent subacromial decompression confers a 26% relative risk reduction (NNT≈4 patients) for revision repair compared to arthroscopic rotator cuff repair alone in large cohorts of patients with partial or complete tears [11]. For complex and revision tears, double-row arthroscopic repair with dermal allograft augmentation has led to improved functional outcomes [9]. Similarly, there were no differences in repair integrity or clinical outcomes between workers' compensation patients undergoing revision arthroscopic repair with an onlay bioinductive implant versus standard revision repair [22].

Patient selection and counseling can be refined using a revision rotator cuff repair prediction score, which helps identify those most likely to benefit from the procedure [8].

Anatomy & Pathophysiology

General Considerations and Outcomes

Successful revision outcomes require a complete understanding of anatomy [5]. Arthroscopic revision rotator cuff repair provides improved pain relief and shoulder function even after prior open repairs [7]. Revision rotator cuff repair improves clinical outcomes and shoulder function at midterm follow-up [15]. However, patients with retears after revision repair do not necessarily have poorer shoulder function [10]. Revision patients should not expect to see the improvements in range of motion that may occur after primary repair [21]. Preoperative forward flexion is a possible prognostic factor for improved outcomes after revision rotator cuff repair [27].

Infection and Systemic Factors

Subclinical shoulder infections are present in more than one-quarter of patients undergoing revision after rotator cuff repair [13, 14]. Dyslipidemia leads to an increased risk of retear after rotator cuff repair [42]. Dyslipidemia is associated with risk for rotator cuff repair failure [42].

Predictors of Failure and Tissue Quality

Rotator cuff tear size (tear dimensions, tear size area, and tear thickness) shows stronger associations with retears at 6 months after surgery than measures of tissue quality and concomitant shoulder injuries [20]. Preoperative functional status is a significant predictor of postoperative outcomes after arthroscopic-assisted latissimus dorsi transfer for irreparable massive rotator cuff tears [12]. A history of failed rotator cuff repair is a significant predictor of postoperative outcomes after arthroscopic-assisted latissimus dorsi transfer for irreparable massive rotator cuff tears [12].

Prior Surgery and Reverse Total Shoulder Arthroplasty

Patients with a history of failed rotator cuff repair, superior capsular reconstruction, or tendon transfer prior to reverse total shoulder arthroplasty have greater range of motion deficits than those without prior ipsilateral shoulder surgery [34, 38]. These patients also have higher complication rates than those without prior ipsilateral shoulder surgery [34, 38]. Furthermore, they have lower clinically significant outcome achievement rates than those without prior ipsilateral shoulder surgery [34, 38]. Failed rotator cuff repair prior to reverse shoulder arthroplasty is associated with lower functional outcomes scores compared to primary reverse shoulder arthroplasty without prior rotator cuff repair [35]. Failed rotator cuff repair prior to reverse shoulder arthroplasty is associated with higher pain scores compared to primary reverse shoulder arthroplasty without prior rotator cuff repair [35]. Failed rotator cuff repair prior to reverse shoulder arthroplasty is associated with worse range of motion compared to primary reverse shoulder arthroplasty without prior rotator cuff repair [35].

Management Strategies

Optimization of surgical techniques and the use of appropriate biologic or tendon transfer techniques is the best method for managing failed rotator cuff repair in young patients [17].

Classification

Revision Repair Outcomes: Revision rotator cuff repair provides significant improvement in pain and function at 5 years postoperation, though outcomes are not as good as primary repair [3]. Successful outcomes require a complete understanding of anatomy, diagnosis of failure causes, and unique technical factors [5]. Recent studies show 52% to 69% satisfactory results for small or medium tears in revision rotator cuff repair [5]. Greater than 60% of arthroscopic revision rotator cuff repairs yield good or excellent results [5]. Arthroscopic revision rotator cuff repair is a reasonable treatment option even after prior open repairs, providing improved pain relief and shoulder function [7]. Patients with retears after revision rotator cuff repair did not necessarily have poorer shoulder function [10].

Prediction and Risk Stratification: A revision rotator cuff repair prediction score can be used in patient counseling and to identify those most likely to benefit from revision repair [8]. Preoperative functional status and a history of failed rotator cuff repair are significant predictors of postoperative outcomes after arthroscopic-assisted latissimus dorsi transfer for irreparable massive rotator cuff tears [12]. A single shoulder injection within a year prior to arthroscopic revision rotator cuff repair was not associated with any increased risk of revision surgery [23]. The administration of 2 or more shoulder injections within a year prior to arthroscopic revision rotator cuff repair was associated with a substantially increased risk of subsequent revision rotator cuff surgery [23].

Subscapularis Involvement: Among revision rotator cuff repairs, 43.1% had neglected subscapularis tears [19]. Fatty infiltration of initially neglected subscapularis tendons showed further progression at the time of revision rotator cuff repair [19].

Other Considerations: Performing concurrent subacromial decompression (SAD) conferred a 26% relative risk reduction (NNT≈4 patients) for revision rotator cuff repair compared to arthroscopic rotator cuff repair (ARCR) alone in a large cohort of over 60,000 patients with partial or complete rotator cuff tears [11].

Study-Specific Classifications and Criteria: * Sugaya Classification: In a study of patients with full-thickness retear after primary arthroscopic rotator cuff repair, 60 consecutive patients were confirmed to have a retear according to the Sugaya classification, and 51 patients were enrolled in the final analysis [25]. Patients were excluded if they had arthritic changes in the glenohumeral joint, had undergone partial repair, had undergone surgery using other techniques (e.g., allodermal patch augmentation and tendon transfer, labral repair), had undergone any previous shoulder surgery, had a history of severe trauma, refused MRI at 1 year postoperatively, or were unable to attend follow-up visits for functional outcome assessments at 2 years postoperatively [25]. Patients were categorized into a good prognosis group (n=36) if they achieved MCID in both UCLA and Constant scores, and a poor prognosis group (n=15) if they did not achieve MCID in either score [25]. * Inclusion/Exclusion Criteria: In the study by [32], inclusion criteria for revision rotator cuff repair were: diagnosis of a reparable full-thickness rotator cuff retear after prior open or arthroscopic repair, full passive range of motion, symptomatic retear despite nonoperative treatment, complete clinical and radiologic follow-up for 2 years, and no other procedure prior to the retear [32]. Patients were excluded if they had osteoarthritis >Hamada 3 or if one of the rotator cuff tendons was considered irreparable (defined as superior migration of the humeral head or fatty infiltration >2 in the Goutallier classification) [32]. * Operative Variables: In the study by [32], 89% of revision rotator cuff repairs were performed arthroscopically and 11% were open [32]. In the study by [32], 65% of revision rotator cuff repairs included acromioplasty and 35% did not [32]. In the study by [32], 24% of revision rotator cuff repairs included tenotomy/tenodesis and 76% did not [32]. In the study by [32], 51% of revision rotator cuff repairs used single-row fixation and 49% used double-row fixation [32].

Clinical Presentation

Revision rotator cuff repair provides significant improvement in pain and function at 5 years postoperation, though outcomes are not as good as primary repair [3]. Clinical outcomes and shoulder function also improve at midterm follow-up (minimum 2 years) [15]. Recent studies show 52% to 69% satisfactory results for small or medium tears and greater than 60% good or excellent results for arthroscopic revisions [5]. Patients with retears did not necessarily have poorer shoulder function [10].

Successful outcomes require a complete understanding of anatomy, diagnosis of failure causes, and unique technical factors [5]. The revision rotator cuff repair prediction score could be used in patient counseling and to identify those most likely to benefit from revision repair [8]. Preoperative functional status and a history of failed rotator cuff repair are significant predictors of postoperative outcomes [12].

Subclinical shoulder infections can be present in more than one-quarter of patients undergoing revision after rotator cuff repair [13, 14]. Patients who had received a corticosteroid injection within 6 months prior to rotator cuff repair were much more likely to undergo a subsequent reoperation within the following 3 years [18].

Fatty infiltration of initially neglected subscapularis tendons showed further progression at the time of revision [19]. Rotator cuff tear size (tear dimensions, tear size area, and tear thickness) showed stronger associations with retears at 6 months after surgery than did measures of tissue quality and concomitant shoulder injuries [20].

Investigations

Clinical and radiographic factors influence the results of revision rotator cuff repair [1]. The results of revision rotator cuff repair are inferior to those of primary repair [1]. Revision rotator cuff repair provides significant improvement in both pain and function at 5 years postoperation [3]. Revision rotator cuff repair outcomes are not as good as primary repair outcomes [3].

Plain radiography: Indicated for initial assessment. Specific signs such as Segond fracture or Pellegrini–Stieda lesion may be evaluated, though specific radiographic findings for revision cuff pathology are not detailed in the provided evidence base.

MRI: There is substantial variability when evaluating MRI scans after rotator cuff repair for identifying rotator cuff retears [33]. Intact revision rotator cuff repair stabilizes muscle atrophy and fatty infiltration after minimum follow-up of two years [45]. Arthroscopic revision rotator cuff repair leads to reliable functional outcomes even in case of a recurrent rotator cuff retear [45].

CT: No specific evidence provided for CT imaging in this section.

Bone scan: No specific evidence provided for bone scan in this section.

Tomosynthesis: No specific evidence provided for tomosynthesis in this section.

Aspiration: No specific evidence provided for joint aspiration in this section.

Laboratory: No specific evidence provided for laboratory studies in this section.

Other Considerations: Successful revision rotator cuff repair outcomes require a complete understanding of anatomy, diagnosis of failure causes, and unique technical factors [5]. Recent studies show greater than 60% good or excellent results for arthroscopic revisions in revision rotator cuff repair [5]. Arthroscopic revision rotator cuff repair may be a reasonable treatment option even after prior open repairs [7]. Arthroscopic revision rotator cuff repair provides improved pain relief and shoulder function [7].

A single shoulder injection within a year prior to arthroscopic rotator cuff repair was not associated with any increased risk of revision surgery [23]. A single shoulder injection within a year prior to arthroscopic rotator cuff repair is not associated with any increased risk of revision surgery [29]. The administration of 2 or more shoulder injections within a year prior to arthroscopic rotator cuff repair was associated with a substantially increased risk of subsequent revision rotator cuff surgery [23]. Patients who had received an injection within 6 months prior to rotator cuff repair were much more likely to undergo a revision cuff repair within the following 3 years [30]. Performing concurrent subacromial decompression conferred a 26% relative risk reduction (NNT≈4 patients) for revision rotator cuff repair when compared to arthroscopic rotator cuff repair alone [24].

Treatment

Non-Operative

Patients who received a corticosteroid injection within 6 months prior to rotator cuff repair were much more likely to undergo a subsequent reoperation within the following 3 years [18].

Operative

Indications: Optimization of surgical techniques and the use of appropriate biologic or tendon transfer techniques, if indicated, is the best method for the management of failed rotator cuff repair in young patients [17].

Surgical Approach / Technique: Clinical results of arthroscopic revision rotator cuff repair show improvements in scores and decreased pain, especially in patients treated with a new repair [41]. Concurrent subacromial decompression confers a 26% relative risk reduction (NNT≈4 patients) for revision rotator cuff repair when compared to arthroscopic rotator cuff repair alone in patients with partial or complete rotator cuff tears [11].

Implant Selection: Double-row arthroscopic repair with dermal allograft augmentation of complex and revision rotator cuff tears leads to improved functional outcomes [9]. Interpositional bridging grafting for revision rotator cuff repair of large and massive retears leads to a significant improvement in functional outcome but is associated with a high retear rate [44]. There are no differences in repair integrity or clinical outcomes between workers' compensation patients who underwent revision arthroscopic rotator cuff repair with an onlay bioinductive implant compared to those who underwent standard revision rotator cuff repair [22].

Other Considerations: Successful outcomes for revision rotator cuff repair are observed at long-term follow-up with and without bioaugmentation [28].

Complications

Injection History: A single shoulder injection within one year prior to arthroscopic revision rotator cuff repair is not associated with any increased risk of subsequent revision surgery [23, 29]. In contrast, the administration of two or more shoulder injections within the same one-year window is associated with a substantially increased risk of subsequent revision surgery [23]. Furthermore, patients who received an injection within six months prior to the procedure were much more likely to undergo revision within the following three years [30].

Other Considerations: There was no apparent effect of platelet-rich plasma (PRP) on the incidence of revision surgery after primary rotator cuff repair [43].

Recovery

Complete recovery / outcome plateau (months): Revision rotator cuff repair provides significant improvement in pain and function at 5 years postoperation [3]. Latissimus transfer, as a salvage procedure for failed rotator cuff repair with loss of elevation, allows for significant return of active elevation and function with minimal post-operative pain [46].

Key Evidence

  • [L5] The major indication for revision rotator cuff repair is the persistence of clinical symptoms despite nonsurgical management in the absence of substantial risk factors for failure. [2] (10.5435/00124635-201111000-00002)
  • [L4] Revision rotator cuff repair provides significant improvement in both pain and function at 5 years postoperation, though not as good as primary repair. [3] (10.1016/j.jse.2019.12.011)
  • [L4] The review indicates that arthroscopic revision rotator cuff repair can lead to improvement in functional outcome despite a high retear rate. [4] (10.1136/jisakos-2015-000027)
  • [L5] Successful outcomes require a complete understanding of anatomy, diagnosis of failure causes, and unique technical factors, with recent studies showing 52% to 69% satisfactory results for small or medium tears and greater than 60% good or excellent results for arthroscopic revisions. [5] (10.1016/j.jse.2011.11.029)
  • [L4] Revision rotator cuff repair provides significant pain relief and improvement in functional scores at long-term follow-up. [6] (10.1016/j.jse.2023.06.009)
  • [L4] Arthroscopic revision rotator cuff repair may be a reasonable treatment option even after prior open repairs and provides both improved pain relief and shoulder function. [7] (10.1177/0363546509346401)
  • [L4] This revision rotator cuff repair prediction score could be used in patient counseling and to identify those most likely to benefit from revision repair. [8] (10.1016/j.jse.2024.12.034)
  • [L4] Double-row arthroscopic repair with dermal allograft augmentation of complex and revision rotator cuff tears led to improved functional outcomes. [9] (10.1177/03635465211015194)
  • [L4] Patients with retears, however, did not necessarily have poorer shoulder function. [10] (10.1177/03635465221097410)
  • [L3] In a large cohort of over 60,000 patients with partial or complete rotator cuff tears, performing concurrent SAD conferred a 26% relative risk reduction (NNT≈4 patients) for revision rotator cuff repair when compared to ARCR alone. [11] (10.1016/j.jisako.2023.03.378)
  • [L4] Preoperative functional status and a history of failed rotator cuff repair are significant predictors of postoperative outcomes. [12] (10.1016/j.jse.2015.08.043)
  • [L4] Subclinical shoulder infections can be present in more than one-quarter of patients undergoing revision after rotator cuff repair. [13] (10.1016/j.asmr.2023.100792)
  • [L3] Subclinical shoulder infections can be present in over one-quarter of patients undergoing revision after rotator cuff repair. [14] (10.1016/j.arthro.2024.11.038)
  • [L4] Revision RCR improves clinical outcomes and shoulder function at midterm follow-up. [15] (10.1177/0363546518786006)
  • [L4] The complication rate after arthroscopic revision rotator cuff repair is about twice the published rate for primary rotator cuff repair. [16] (10.1016/j.arthro.2013.06.015)
  • [L5] Optimization of surgical techniques and the use of appropriate biologic or tendon transfer techniques, if indicated, is the best method for the management of failed rotator cuff repair. [17] (10.5435/jaaos-d-17-00086)
  • [L3] Patients who had received a corticosteroid injection within 6 months prior to rotator cuff repair were much more likely to undergo a subsequent reoperation within the following 3 years. [18] (10.1177/2325967118s00006)
  • [L4] Among revision rotator cuff repairs, 43.1% had neglected subscapularis tears, and fatty infiltration of these initially neglected subscapularis tendons showed further progression at the time of revision. [19] (10.1177/03635465211047485)
  • [L3] Nevertheless, rotator cuff tear size (tear dimensions, tear size area, and tear thickness) showed stronger associations with retears at 6 months after surgery than did measures of tissue quality and concomitant shoulder injuries. [20] (10.1177/0363546514525336)
  • [L3] Revision patients should not expect to see the improvements in ROM that may occur after primary repair. [21] (10.1016/j.jse.2024.05.011)
  • [L3] There were no differences in repair integrity or clinical outcomes between workers' compensation patients who underwent revision arthroscopic rotator cuff repair with an onlay bioinductive implant compared to those who underwent standard revision rotator cuff repair. [22] (10.1177/23259671231175883)
  • [L3] A single shoulder injection within a year prior to arthroscopic RCR was not associated with any increased risk of revision surgery; however, the administration of 2 or more injections was associated with a substantially increased risk of subsequent revision rotator cuff surgery. [23] (10.1016/j.arthro.2018.07.043)
  • [L3] Performing concurrent SAD conferred a 26% relative risk reduction (NNT≈4 patients) for revision rotator cuff repair when compared to ARCR alone. [24] (10.1177/2325967123s00187)
  • [L3] [25] (10.1177/03635465221128232)
  • [L4] Preoperative forward flexion was identified as a possible prognostic factor for improved outcomes. [27] (10.1016/j.jse.2019.06.023)
  • [L3] Successful outcomes were observed at long-term follow-up for revision rotator cuff repair with and without bioaugmentation. [28] (10.1016/j.jseint.2024.04.009)
  • [L3] A single shoulder injection within a year prior to arthroscopic RCR is not associated with any increased risk of revision surgery. [29] (10.1177/2325967118s00081)
  • [L3] Patients who had received an injection within 6 months prior to RCR were much more likely to undergo a revision cuff repair within the following 3 years. [30] (10.1016/j.arthro.2018.10.107)
  • [L3] [32] (10.1016/j.jse.2023.06.028)
  • [L3] The results of this study indicate that there is substantial variability when evaluating MRI scans after rotator cuff repair. [33] (10.1177/0363546512449424)
  • [L3] Patients with a history of a failed RCR, SCR, or TT prior to RTSA have greater range of motion deficits, higher complication rates, and lower clinically significant outcome achievement rates than those without prior ipsilateral shoulder surgery. [34] (10.1177/2325967125s00121)
  • [L1] Failed rotator cuff repair prior to reverse shoulder arthroplasty was associated with lower functional outcomes scores, higher pain scores, and worse range of motion compared to primary reverse shoulder arthroplasty without prior rotator cuff repair. [35] (10.1177/17585732231194785)
  • [L3] Patients with a history of failed rotator cuff repair, superior capsular reconstruction, or tendon transfer before RTSA had greater range of motion deficits, higher complication rates, and lower rates of achieving clinically significant outcomes than those without prior ipsilateral shoulder surgery. [38] (10.1177/03635465251346163)
  • [L4] Clinical results showed improvements in scores and decreased pain, especially in patients treated with a new repair. [41] (10.1016/j.jse.2021.03.121)
  • [L1] DLD leads to an increased risk of retear after rotator cuff repair, although function appears to be unimpaired. [42] (10.1016/j.xrrt.2022.02.003)
  • [L3] There was no apparent effect of PRP on the incidence of revision surgery after primary rotator cuff repair. [43] (10.1177/23259671221127004)
  • [L4] Interpositional bridging grafting for revision rotator cuff repair of large and massive retears leads to a significant improvement in functional outcome but is associated with a high retear rate. [44] (10.1016/j.jseint.2022.02.010)
  • [L4] Arthroscopic revision RCR leads to reliable functional outcomes even in case of a recurrent RC retear. [45] (10.1186/s12891-023-06616-2)
  • [L4] Latissimus transfer, as a salvage procedure for failed rotator cuff repair with loss of elevation, allows for significant return of active elevation and function with minimal post-operative pain. [46] (10.1016/j.jse.2008.04.007)

See Also

References

[1] Clinical and radiographic factors influencing the results of revision rotator cuff repair. 2013.

[2] Arthroscopic Revision Rotator Cuff Repair. American Academy of Orthopaedic Surgeon. 2011. DOI: 10.5435/00124635-201111000-00002

[3] Medium-term outcomes of a cohort of revision rotator cuff repairs. Journal of Shoulder and Elbow Surgery. 2020. DOI: 10.1016/j.jse.2019.12.011

[4] Management of failed rotator cuff repair: a systematic review. Journal of ISAKOS. 2016. DOI: 10.1136/jisakos-2015-000027

[5] Current concepts review: revision rotator cuff repair. Journal of Shoulder and Elbow Surgery. 2012. DOI: 10.1016/j.jse.2011.11.029

[6] Long-term results of revision rotator cuff repair for failed cuff repair: a minimum 10-year follow-up study. Journal of Shoulder and Elbow Surgery. 2024. DOI: 10.1016/j.jse.2023.06.009

[7] Outcomes after Arthroscopic Revision Rotator Cuff Repair. The American Journal of Sports Medicine. 2009. DOI: 10.1177/0363546509346401

[8] Predicting good clinical outcomes after revision rotator cuff repair: the revision cuff repair prediction score. Journal of Shoulder and Elbow Surgery. 2025. DOI: 10.1016/j.jse.2024.12.034

[9] Healing and Functional Results of Dermal Allograft Augmentation of Complex and Revision Rotator Cuff Repairs. The American Journal of Sports Medicine. 2021. DOI: 10.1177/03635465211015194

[10] Results of Arthroscopic Revision Rotator Cuff Repair for Failed Open or Arthroscopic Repair: A Prospective Multicenter Study on 100 Cases. The American Journal of Sports Medicine. 2022. DOI: 10.1177/03635465221097410

[11] Subacromial Decompression is Associated with a Number Needed to Treat of 4 for Reduced Revision Rotator Cuff Repair: A Large Matched Cohort Insurance Database Analysis. Journal of ISAKOS. 2023. DOI: 10.1016/j.jisako.2023.03.378

[12] Functional status and failed rotator cuff repair predict outcomes after arthroscopic-assisted latissimus dorsi transfer for irreparable massive rotator cuff tears. Journal of Shoulder and Elbow Surgery. 2016. DOI: 10.1016/j.jse.2015.08.043

[13] A High Rate of Bacteriologic Culture‐Positive Findings Is Seen After Revision Rotator Cuff Surgery. Arthroscopy, Sports Medicine, and Rehabilitation. 2023. DOI: 10.1016/j.asmr.2023.100792

[14] Podium Presentation Title: The Incidence of Subclinical Infection in Revision Rotator Cuff Surgery. Arthroscopy. 2025. DOI: 10.1016/j.arthro.2024.11.038

[15] Clinical Outcomes, Tendon Integrity, and Shoulder Strength After Revision Rotator Cuff Reconstruction: A Minimum 2 Years’ Follow-up. The American Journal of Sports Medicine. 2018. DOI: 10.1177/0363546518786006

[16] Complications After Arthroscopic Revision Rotator Cuff Repair. Arthroscopy. 2013. DOI: 10.1016/j.arthro.2013.06.015

[17] Management of Failed Rotator Cuff Repair in Young Patients. Journal of the American Academy of Orthopaedic Surgeons. 2017. DOI: 10.5435/jaaos-d-17-00086

[18] Preoperative Shoulder Injections are Associated with Increased Risk of Subsequent Revision Rotator Cuff Repair. Orthopaedic Journal of Sports Medicine. 2018. DOI: 10.1177/2325967118s00006

[19] Arthroscopic Revision Rotator Cuff Repair: The Role of Previously Neglected Subscapularis Tears. The American Journal of Sports Medicine. 2021. DOI: 10.1177/03635465211047485

[20] Factors Predicting Rotator Cuff Retears. The American Journal of Sports Medicine. 2014. DOI: 10.1177/0363546514525336

[21] Revision rotator cuff repair versus primary repair: an assessment of longitudinal outcomes in revision rotator cuff repair. Journal of Shoulder and Elbow Surgery. 2025. DOI: 10.1016/j.jse.2024.05.011

[22] Revision Rotator Cuff Repair With Versus Without an Arthroscopically Inserted Onlay Bioinductive Implant in Workers’ Compensation Patients. Orthopaedic Journal of Sports Medicine. 2023. DOI: 10.1177/23259671231175883

[23] Increasing Numbers of Shoulder Corticosteroid Injections Within a Year Preoperatively May Be Associated With a Higher Rate of Subsequent Revision Rotator Cuff Surgery. Arthroscopy: The Journal of Arthroscopic & Related Surgery. 2019. DOI: 10.1016/j.arthro.2018.07.043

[24] Poster 202: Subacromial Decompression is Associated with a Number Needed to Treat of 4 for Reduced Revision Rotator Cuff Repair: A Large Matched Cohort Insurance Database Analysis. Orthopaedic Journal of Sports Medicine. 2023. DOI: 10.1177/2325967123s00187

[25] Prognostic Factors Leading to Good or Poor Outcomes Based on Functional and Radiological Findings After a Rotator Cuff Retear. The American Journal of Sports Medicine. 2022. DOI: 10.1177/03635465221128232

[27] Revision rotator cuff repair: a systematic review. Journal of Shoulder and Elbow Surgery. 2020. DOI: 10.1016/j.jse.2019.06.023

[28] Bioaugmentation demonstrates similar outcomes and failure rates for arthroscopic revision rotator cuff repair compared to revision without bioaugmentation. JSES International. 2024. DOI: 10.1016/j.jseint.2024.04.009

[29] Increasing Numbers of Pre-operative Shoulder Injections are Associated with a Higher Rate of Subsequent Revision Rotator Cuff Surgery. Orthopaedic Journal of Sports Medicine. 2018. DOI: 10.1177/2325967118s00081

[30] Preoperative Shoulder Injections Are Associated With Increased Risk of Revision Rotator Cuff Repair. Arthroscopy. 2019. DOI: 10.1016/j.arthro.2018.10.107

[32] Revision rotator cuff repair: can a Sugaya III tendon considered to be healed or not. Journal of Shoulder and Elbow Surgery. 2024. DOI: 10.1016/j.jse.2023.06.028

[33] Magnetic Resonance Imaging Identification of Rotator Cuff Retears After Repair. The American Journal of Sports Medicine. 2012. DOI: 10.1177/0363546512449424

[34] Poster 7: The Bridge is On Fire: Outcomes of Reverse Shoulder Arthroplasty After Failed Rotator Cuff Repair, Superior Capsular Reconstruction and Tendon Transfer. Orthopaedic Journal of Sports Medicine. 2025. DOI: 10.1177/2325967125s00121

[35] Reverse shoulder arthroplasty following failed rotator cuff repair: A systematic review and meta-analysis. Shoulder & Elbow. 2023. DOI: 10.1177/17585732231194785

[38] Outcomes of Reverse Total Shoulder Arthroplasty After Failed Rotator Cuff Repair, Superior Capsular Reconstruction, and Tendon Transfer. The American Journal of Sports Medicine. 2025. DOI: 10.1177/03635465251346163

[41] Arthroscopic Surgery of Rotator Cuff Retear: New Repair Versus Tendon Transfer. Journal of Shoulder and Elbow Surgery. 2021. DOI: 10.1016/j.jse.2021.03.121

[42] Dyslipidemia is associated with risk for rotator cuff repair failure: a systematic review and meta-analysis. JSES Reviews, Reports, and Techniques. 2022. DOI: 10.1016/j.xrrt.2022.02.003

[43] Effect of Bone Marrow Aspirate Concentrate and Platelet-Rich Plasma Augmentation on the Rate of Revision Rotator Cuff Repair. Orthopaedic Journal of Sports Medicine. 2022. DOI: 10.1177/23259671221127004

[44] Arthroscopic revision rotator cuff repair of large and massive retears using an interpositional bridging dermal allograft. JSES International. 2022. DOI: 10.1016/j.jseint.2022.02.010

[45] Intact revision rotator cuff repair stabilizes muscle atrophy and fatty infiltration after minimum follow up of two years. BMC Musculoskeletal Disorders. 2023. DOI: 10.1186/s12891-023-06616-2

[46] Outcome of latissimus dorsi transfer as a salvage procedure for failed rotator cuff repair with loss of elevation. Journal of Shoulder and Elbow Surgery. 2008. DOI: 10.1016/j.jse.2008.04.007

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Creative Commons Attribution-NonCommercial 4.0 International Public License

By exercising the Licensed Rights (defined below), You accept and agree to be bound by the terms and conditions of this Creative Commons Attribution-NonCommercial 4.0 International Public License ("Public License"). To the extent this Public License may be interpreted as a contract, You are granted the Licensed Rights in consideration of Your acceptance of these terms and conditions, and the Licensor grants You such rights in consideration of benefits the Licensor receives from making the Licensed Material available under these terms and conditions.

Section 1 -- Definitions.

a. Adapted Material means material subject to Copyright and Similar Rights that is derived from or based upon the Licensed Material and in which the Licensed Material is translated, altered, arranged, transformed, or otherwise modified in a manner requiring permission under the Copyright and Similar Rights held by the Licensor. For purposes of this Public License, where the Licensed Material is a musical work, performance, or sound recording, Adapted Material is always produced where the Licensed Material is synched in timed relation with a moving image.

b. Adapter's License means the license You apply to Your Copyright and Similar Rights in Your contributions to Adapted Material in accordance with the terms and conditions of this Public License.

c. Copyright and Similar Rights means copyright and/or similar rights closely related to copyright including, without limitation, performance, broadcast, sound recording, and Sui Generis Database Rights, without regard to how the rights are labeled or categorized. For purposes of this Public License, the rights specified in Section 2(b)(1)-(2) are not Copyright and Similar Rights.

d. Effective Technological Measures means those measures that, in the absence of proper authority, may not be circumvented under laws fulfilling obligations under Article 11 of the WIPO Copyright Treaty adopted on December 20, 1996, and/or similar international agreements.

e. Exceptions and Limitations means fair use, fair dealing, and/or any other exception or limitation to Copyright and Similar Rights that applies to Your use of the Licensed Material.

f. Licensed Material means the artistic or literary work, database, or other material to which the Licensor applied this Public License.

g. Licensed Rights means the rights granted to You subject to the terms and conditions of this Public License, which are limited to all Copyright and Similar Rights that apply to Your use of the Licensed Material and that the Licensor has authority to license.

h. Licensor means the individual(s) or entity(ies) granting rights under this Public License.

i. NonCommercial means not primarily intended for or directed towards commercial advantage or monetary compensation. For purposes of this Public License, the exchange of the Licensed Material for other material subject to Copyright and Similar Rights by digital file-sharing or similar means is NonCommercial provided there is no payment of monetary compensation in connection with the exchange.

j. Share means to provide material to the public by any means or process that requires permission under the Licensed Rights, such as reproduction, public display, public performance, distribution, dissemination, communication, or importation, and to make material available to the public including in ways that members of the public may access the material from a place and at a time individually chosen by them.

k. Sui Generis Database Rights means rights other than copyright resulting from Directive 96/9/EC of the European Parliament and of the Council of 11 March 1996 on the legal protection of databases, as amended and/or succeeded, as well as other essentially equivalent rights anywhere in the world.

l. You means the individual or entity exercising the Licensed Rights under this Public License. Your has a corresponding meaning.

Section 2 -- Scope.

a. License grant.

1. Subject to the terms and conditions of this Public License, the Licensor hereby grants You a worldwide, royalty-free, non-sublicensable, non-exclusive, irrevocable license to exercise the Licensed Rights in the Licensed Material to:

a. reproduce and Share the Licensed Material, in whole or in part, for NonCommercial purposes only; and

b. produce, reproduce, and Share Adapted Material for NonCommercial purposes only.

2. Exceptions and Limitations. For the avoidance of doubt, where Exceptions and Limitations apply to Your use, this Public License does not apply, and You do not need to comply with its terms and conditions.

3. Term. The term of this Public License is specified in Section 6(a).

4. Media and formats; technical modifications allowed. The Licensor authorizes You to exercise the Licensed Rights in all media and formats whether now known or hereafter created, and to make technical modifications necessary to do so. The Licensor waives and/or agrees not to assert any right or authority to forbid You from making technical modifications necessary to exercise the Licensed Rights, including technical modifications necessary to circumvent Effective Technological Measures. For purposes of this Public License, simply making modifications authorized by this Section 2(a) (4) never produces Adapted Material.

5. Downstream recipients.

a. Offer from the Licensor -- Licensed Material. Every recipient of the Licensed Material automatically receives an offer from the Licensor to exercise the Licensed Rights under the terms and conditions of this Public License.

b. No downstream restrictions. You may not offer or impose any additional or different terms or conditions on, or apply any Effective Technological Measures to, the Licensed Material if doing so restricts exercise of the Licensed Rights by any recipient of the Licensed Material.

6. No endorsement. Nothing in this Public License constitutes or may be construed as permission to assert or imply that You are, or that Your use of the Licensed Material is, connected with, or sponsored, endorsed, or granted official status by, the Licensor or others designated to receive attribution as provided in Section 3(a)(1)(A)(i).

b. Other rights.

1. Moral rights, such as the right of integrity, are not licensed under this Public License, nor are publicity, privacy, and/or other similar personality rights; however, to the extent possible, the Licensor waives and/or agrees not to assert any such rights held by the Licensor to the limited extent necessary to allow You to exercise the Licensed Rights, but not otherwise.

2. Patent and trademark rights are not licensed under this Public License.

3. To the extent possible, the Licensor waives any right to collect royalties from You for the exercise of the Licensed Rights, whether directly or through a collecting society under any voluntary or waivable statutory or compulsory licensing scheme. In all other cases the Licensor expressly reserves any right to collect such royalties, including when the Licensed Material is used other than for NonCommercial purposes.

Section 3 -- License Conditions.

Your exercise of the Licensed Rights is expressly made subject to the following conditions.

a. Attribution.

1. If You Share the Licensed Material (including in modified form), You must:

a. retain the following if it is supplied by the Licensor with the Licensed Material:

i. identification of the creator(s) of the Licensed Material and any others designated to receive attribution, in any reasonable manner requested by the Licensor (including by pseudonym if designated);

ii. a copyright notice;

iii. a notice that refers to this Public License;

iv. a notice that refers to the disclaimer of warranties;

v. a URI or hyperlink to the Licensed Material to the extent reasonably practicable;

b. indicate if You modified the Licensed Material and retain an indication of any previous modifications; and

c. indicate the Licensed Material is licensed under this Public License, and include the text of, or the URI or hyperlink to, this Public License.

2. You may satisfy the conditions in Section 3(a)(1) in any reasonable manner based on the medium, means, and context in which You Share the Licensed Material. For example, it may be reasonable to satisfy the conditions by providing a URI or hyperlink to a resource that includes the required information.

3. If requested by the Licensor, You must remove any of the information required by Section 3(a)(1)(A) to the extent reasonably practicable.

4. If You Share Adapted Material You produce, the Adapter's License You apply must not prevent recipients of the Adapted Material from complying with this Public License.

Section 4 -- Sui Generis Database Rights.

Where the Licensed Rights include Sui Generis Database Rights that apply to Your use of the Licensed Material:

a. for the avoidance of doubt, Section 2(a)(1) grants You the right to extract, reuse, reproduce, and Share all or a substantial portion of the contents of the database for NonCommercial purposes only;

b. if You include all or a substantial portion of the database contents in a database in which You have Sui Generis Database Rights, then the database in which You have Sui Generis Database Rights (but not its individual contents) is Adapted Material; and

c. You must comply with the conditions in Section 3(a) if You Share all or a substantial portion of the contents of the database.

For the avoidance of doubt, this Section 4 supplements and does not replace Your obligations under this Public License where the Licensed Rights include other Copyright and Similar Rights.

Section 5 -- Disclaimer of Warranties and Limitation of Liability.

a. UNLESS OTHERWISE SEPARATELY UNDERTAKEN BY THE LICENSOR, TO THE EXTENT POSSIBLE, THE LICENSOR OFFERS THE LICENSED MATERIAL AS-IS AND AS-AVAILABLE, AND MAKES NO REPRESENTATIONS OR WARRANTIES OF ANY KIND CONCERNING THE LICENSED MATERIAL, WHETHER EXPRESS, IMPLIED, STATUTORY, OR OTHER. THIS INCLUDES, WITHOUT LIMITATION, WARRANTIES OF TITLE, MERCHANTABILITY, FITNESS FOR A PARTICULAR PURPOSE, NON-INFRINGEMENT, ABSENCE OF LATENT OR OTHER DEFECTS, ACCURACY, OR THE PRESENCE OR ABSENCE OF ERRORS, WHETHER OR NOT KNOWN OR DISCOVERABLE. WHERE DISCLAIMERS OF WARRANTIES ARE NOT ALLOWED IN FULL OR IN PART, THIS DISCLAIMER MAY NOT APPLY TO YOU.

b. TO THE EXTENT POSSIBLE, IN NO EVENT WILL THE LICENSOR BE LIABLE TO YOU ON ANY LEGAL THEORY (INCLUDING, WITHOUT LIMITATION, NEGLIGENCE) OR OTHERWISE FOR ANY DIRECT, SPECIAL, INDIRECT, INCIDENTAL, CONSEQUENTIAL, PUNITIVE, EXEMPLARY, OR OTHER LOSSES, COSTS, EXPENSES, OR DAMAGES ARISING OUT OF THIS PUBLIC LICENSE OR USE OF THE LICENSED MATERIAL, EVEN IF THE LICENSOR HAS BEEN ADVISED OF THE POSSIBILITY OF SUCH LOSSES, COSTS, EXPENSES, OR DAMAGES. WHERE A LIMITATION OF LIABILITY IS NOT ALLOWED IN FULL OR IN PART, THIS LIMITATION MAY NOT APPLY TO YOU.

c. The disclaimer of warranties and limitation of liability provided above shall be interpreted in a manner that, to the extent possible, most closely approximates an absolute disclaimer and waiver of all liability.

Section 6 -- Term and Termination.

a. This Public License applies for the term of the Copyright and Similar Rights licensed here. However, if You fail to comply with this Public License, then Your rights under this Public License terminate automatically.

b. Where Your right to use the Licensed Material has terminated under Section 6(a), it reinstates:

1. automatically as of the date the violation is cured, provided it is cured within 30 days of Your discovery of the violation; or

2. upon express reinstatement by the Licensor.

For the avoidance of doubt, this Section 6(b) does not affect any right the Licensor may have to seek remedies for Your violations of this Public License.

c. For the avoidance of doubt, the Licensor may also offer the Licensed Material under separate terms or conditions or stop distributing the Licensed Material at any time; however, doing so will not terminate this Public License.

d. Sections 1, 5, 6, 7, and 8 survive termination of this Public License.

Section 7 -- Other Terms and Conditions.

a. The Licensor shall not be bound by any additional or different terms or conditions communicated by You unless expressly agreed.

b. Any arrangements, understandings, or agreements regarding the Licensed Material not stated herein are separate from and independent of the terms and conditions of this Public License.

Section 8 -- Interpretation.

a. For the avoidance of doubt, this Public License does not, and shall not be interpreted to, reduce, limit, restrict, or impose conditions on any use of the Licensed Material that could lawfully be made without permission under this Public License.

b. To the extent possible, if any provision of this Public License is deemed unenforceable, it shall be automatically reformed to the minimum extent necessary to make it enforceable. If the provision cannot be reformed, it shall be severed from this Public License without affecting the enforceability of the remaining terms and conditions.

c. No term or condition of this Public License will be waived and no failure to comply consented to unless expressly agreed to by the Licensor.

d. Nothing in this Public License constitutes or may be interpreted as a limitation upon, or waiver of, any privileges and immunities that apply to the Licensor or You, including from the legal processes of any jurisdiction or authority.

Creative Commons is not a party to its public licenses. Notwithstanding, Creative Commons may elect to apply one of its public licenses to material it publishes and in those instances will be considered the “Licensor.” The text of the Creative Commons public licenses is dedicated to the public domain under the CC0 Public Domain Dedication. Except for the limited purpose of indicating that material is shared under a Creative Commons public license or as otherwise permitted by the Creative Commons policies published at creativecommons.org/policies, Creative Commons does not authorize the use of the trademark "Creative Commons" or any other trademark or logo of Creative Commons without its prior written consent including, without limitation, in connection with any unauthorized modifications to any of its public licenses or any other arrangements, understandings, or agreements concerning use of licensed material. For the avoidance of doubt, this paragraph does not form part of the public licenses.

Creative Commons may be contacted at creativecommons.org.