Revision Rotator Cuff Repair in Dallas: When a Repair Has Failed

Can a failed rotator cuff repair be fixed? Often, yes. When a repaired tendon pulls away from the bone again and the shoulder is painful or weak, a second repair, called a revision, can relieve pain and restore function in the right patient. But not every retear needs another operation: many cause few symptoms, and some shoulders do better with a different approach. The first step is understanding why the first repair failed, what the tendon and muscle look like now, and whether the tendon can be brought back to the bone.

Dr. Brett Raynor is a fellowship-trained orthopaedic sports medicine surgeon at Texas Orthopaedic Associates in Dallas. Rotator cuff repair is one of the operations he performs most often, and other surgeons refer large and revision repairs to him. Whoever did your first surgery, he will review your records and images, tell you honestly whether a revision makes sense, and if it does, exactly how he would do it.

Key points

  • Retears are not rare, but most do not lead to another operation, and many cause few symptoms.

  • Repairs fail most often because the tendon did not heal to the bone, which is more likely with large tears, retracted tendons, poor muscle quality, older age, diabetes, smoking and repeated steroid injections.

  • Evaluation starts with your operative report, X-rays and an MRI.

  • A revision deals with the old anchors, frees up the tendon so it reaches, and often adds reinforcement such as a patch or graft.

  • Recovery is more cautious than after a first repair.

How often do rotator cuff repairs fail?

In a systematic review of more than 60,000 arthroscopic rotator cuff repairs followed at least two years, studies found an overall retear rate of about 17% and a revision surgery rate of about 4%, which suggests that most retears do not cause enough trouble to need another operation (Davey et al., Bone Joint J, 2025). In a meta-analysis of patients followed at least a year after repair, pain and function improved whether or not the repair had healed, though patients whose repairs were intact were stronger (Russell et al., J Bone Joint Surg Am, 2014).

So a retear on an MRI is a finding, not an automatic operation. What matters is how the shoulder is doing and what the tear looks like.

Why rotator cuff repairs fail

The tendon did not heal to the bone. This is the most common reason. A repair holds the tendon in place, but the tendon has to grow back into the bone over the following months, and some tendons do not. In meta-analyses, factors associated with retears included older age, diabetes, larger tears, a tendon that had pulled further back, fatty change in the muscle and a longer duration of symptoms before surgery (Zhao et al., J Shoulder Elbow Surg, 2021). Smoking about doubled the risk of retear (Fan et al., J Shoulder Elbow Surg, 2022).

Steroid injections. One or two injections over the course of treatment are reasonable. More can weaken the tendon, and in a systematic review, two or more injections in the year before a repair were associated with about two to three times the rate of revision surgery (Cimino et al., Arthroscopy, 2020).

A new injury. A fall, a sudden pull or lifting something heavy before the tendon has healed can tear a repair that was healing well.

Tissue that could not hold. Thin or worn tendon can let stitches pull through before the tendon heals, especially in large tears.

The pain was not only the cuff. Sometimes a shoulder still hurts after a repair that healed, because another source of pain, often the biceps tendon, stiffness or arthritis, was part of the problem. Sorting this out is part of the evaluation.

Symptoms of a failed rotator cuff repair

  • Pain that improved after surgery and then came back, or never really improved

  • New weakness lifting the arm, especially after a fall or a pop

  • Trouble raising the arm overhead that was not there a few months after surgery

  • Night pain that persists well beyond the expected recovery

Some stiffness, soreness and weakness are expected for months after any cuff repair; that is the normal course of recovery, not failure. The tendon is healed at about four months and strengthening is still in progress then. If you are not sure whether what you feel is normal, start with your surgeon, and get a second opinion if the answer does not make sense.

How Dr. Raynor evaluates a failed repair

Your records. The operative report from your first surgery tells him how the tendon was repaired, how many anchors were used and what they are made of, whether the biceps was treated, and what the tissue looked like. Arthroscopic pictures help too.

The story. When the first surgery was, how the recovery went, whether there was a new injury, and every injection since.

The exam. Motion, strength in each of the four cuff tendons, and the biceps. How high you can lift the arm before a revision matters: in a systematic review of revision repairs, forward elevation before surgery was the strongest predictor of the final result (Brochin et al., J Shoulder Elbow Surg, 2020).

X-rays. They show arthritis, whether the ball has ridden up, and the position of any hardware that shows. Most modern anchors do not show up on X-ray, which is one reason the operative report matters. The exception is the small metal button sometimes used when the biceps is fixed lower on the arm.

MRI. An MRI after a previous repair shows whether the tendon has retorn, how big the gap is, how far the tendon has pulled back, and the quality of the muscle behind it, including fatty change. Scar and old hardware make these scans harder to read, so Dr. Raynor reviews the images himself rather than relying on the report. If your scan is more than a few months old and surgery is on the table, he will usually get a new one.

What to bring. Your operative report and any arthroscopic pictures, the MRI images themselves (not just the report) from before and after the first surgery if you have them, X-rays, your therapy notes, and a list of every shoulder injection with approximate dates.

Who is a good candidate for revision repair?

The best candidates have a retear that can be brought back to the bone, a muscle that is still in reasonable shape, no significant arthritis, and a shoulder that still lifts reasonably well. In a review of failed repairs, the most favorable situation was a small retear with good-quality muscle and tendon and no arthritis, in a patient under 70 with more than 90 degrees of forward elevation (Desmoineaux, Orthop Traumatol Surg Res, 2019). Being outside that picture does not rule out a revision; it changes the plan, often toward reinforcement or one of the options for a tear that cannot be closed.

What revision rotator cuff repair involves

The surgery is done under general anesthesia, typically with a breathing tube because you sit upright in the beach chair position, plus an interscalene nerve block placed in the operating room just before you go to sleep. Almost all revisions are done arthroscopically, through small poke-hole incisions and a camera, and you go home the same day. Dr. Raynor:

  1. Looks at everything first. The tendon, the old repair, the anchors and sutures, the biceps, the cartilage and the joint lining, to confirm the plan made from your MRI.

  2. Clears the old repair. Scar tissue and loose or broken sutures from the first surgery are removed.

  3. Deals with the old anchors. Depending on where they sit and how solid the bone is, he either places new anchors into the same holes or works around the old ones.

  4. Frees the tendon so it reaches. A tendon that has retorn is often scarred down and pulled back. He releases it from the scar around it so it can be brought back to the bone without too much tension.

  5. Prepares the bone and repairs the tendon. The bone where the tendon belongs is roughened so it bleeds, and the tendon is repaired with new anchors and sutures, using the same double-row approach as a standard repair whenever the tissue allows.

  6. Reinforces the repair, often. Revisions frequently need extra help, because the tissue has already failed once. Dr. Raynor's options include a collagen patch on top of the repair to help the tendon heal and thicken, a tissue graft on top to reinforce it, a fiber-based augment that reinforces the stitches' hold in the tendon, and, when the top of the cuff cannot be closed, a superior capsular reconstruction or the biceps tendon used as a graft. Each is explained on the massive and irreparable rotator cuff tears page.

  7. Treats the biceps. If the biceps tendon was not addressed the first time, Dr. Raynor typically treats it now, either moving it out of its groove (a tenodesis) or transferring it so it can be used as a graft.

Most of this is planned before surgery from your images. The camera confirms the details, and you will know beforehand what Dr. Raynor expects to do and what his backup plan is.

What studies show about revision repair

Revision repair generally helps, but it is a harder problem than a first repair, and the results are less predictable.

  • In a study of arthroscopic revision repairs followed at least two years, pain, function and motion improved significantly, and 48% of the repairs were intact on ultrasound. Single-tendon repairs healed far more often than repairs of two tendons (70% versus 27%), younger patients healed more often, and shoulders with an intact repair were stronger (Keener et al., J Bone Joint Surg Am, 2010).

  • A systematic review of 22 studies found favorable clinical outcomes after revision repair, with the best results in shoulders that lifted well before surgery (Brochin et al., 2020).

  • A review of failed and revision repairs concluded that results after revision are typically favorable but not as good as after a first repair (MacLean and Brockmeier, Clin Sports Med, 2023).

  • In a small study of revision repairs reinforced with a tissue graft, 4 of the 13 patients who had follow-up imaging had retorn, and shoulder scores improved (Hohn et al., J Shoulder Elbow Surg, 2018). In another, graft-reinforced revisions improved clearly but recovered less strength than first-time repairs (Merolla et al., Int Orthop, 2025).

Dr. Raynor's view is the same as for any repair: getting as much of the tendon as possible to heal and then getting the shoulder strong is what gives you a shoulder that does what you need it to do.

When revision is not the answer

  • The retear is not causing much trouble. Many retears are tolerated well. Physical therapy and time may be the better plan.

  • The tendon will not reach or the muscle has wasted. Then a repeat repair is likely to fail again, and one of the options for a tear that cannot be closed fits better: partial repair, a patch or graft, superior capsular reconstruction, the biceps used as a graft, or, for some older patients, a balloon spacer. See massive and irreparable rotator cuff tears.

  • The cuff cannot be fixed, or arthritis has set in. A reverse shoulder replacement can be the better option when the cuff cannot be repaired and the ball has ridden up toward the bone above it; when an older patient's tear cannot be fixed; when the front tendon (the subscapularis) is also torn and the arm cannot be lifted actively, which is called pseudoparalysis; or when the tear has gone on to arthritis. Dr. Raynor performs shoulder replacement in carefully selected patients, and if your shoulder has reached that point, he will talk through whether it is the right next step for you.

  • The problem is stiffness or something else. A stiff shoulder after surgery is treated differently from a torn one, and pain from the biceps, the neck or the joint itself needs its own answer.

Recovery after revision rotator cuff repair

Recovery follows the same roadmap as a large repair, with a more cautious start: the shoulder stays still longer early on, and strengthening builds more gradually. How much it hurts varies a lot from person to person, but this is not an operation where you feel good right away: the tendon has to heal and then get strong, which takes a few months.

When What is happening
Surgery to week 4 Sling full-time, including at night. Physical therapy starts 1 to 2 weeks after surgery with the elbow, wrist, hand and posture. The shoulder itself stays still for 4 weeks instead of the usual 2.
Weeks 4 to 6 Sling continues. Your therapist moves the shoulder for you, within limits. Stiffness is expected.
Weeks 6 to 12 Sling off at 6 weeks. Active-assisted motion begins around 6 weeks. Normal light use below shoulder level.
Months 3 to 6 Strengthening starts around 3 months and progresses more gradually. The tendon is healed at about 4 months.
6 months to 1 year Most people are doing what they want by about 6 months, though a revision can take longer. It is often about a year before you stop thinking about the shoulder.

If your biceps was moved (a tenodesis), avoid resisted elbow bending, curls and carrying things with the elbow bent for about 12 weeks. If you smoke, stopping before surgery gives the repair a better chance. The full stage-by-stage guide, including the massive and revision track, is on the recovery roadmap.

Second opinions after a failed repair

Second opinions are a regular part of Dr. Raynor's practice, and other surgeons refer revision repairs to him. A second opinion after a failed repair answers four questions: why it failed, whether the tendon can be brought back to the bone, whether reinforcement is needed, and whether a revision is the right operation at all. Sometimes the honest answer is a revision repair; sometimes it is one of the alternatives for a tear that cannot be closed, or more time and therapy. He will tell you which, and why. More on second opinions for rotator cuff surgery.

Traveling to Dallas. If you live outside Dallas-Fort Worth, Dr. Raynor's team will often offer to review your images before you travel and tell you whether a trip to Dallas for surgery is likely to be worth it. This is an informal look at your images, not an official telemedicine visit. If you have surgery here, plan to stay in Dallas for at least two weeks afterward, sometimes up to six depending on what is done; therapy afterward can be done close to home.

Frequently asked questions

  • Pain that came back after improving, new weakness, especially after a fall or a pop, or trouble lifting the arm that was not there a few months after surgery are the usual signs. An exam and usually an MRI confirm it.

  • Some pain, stiffness and weakness are normal for several months; the tendon is healed at about four months and strengthening is still in progress then. Pain that is getting worse, new weakness, or no progress at all deserves a look.

  • No. A full-thickness retear does not heal back to the bone on its own. Many retears are tolerated well, though, and do not need another operation.

  • No. Studies have found that most retears do not lead to revision surgery. The decision depends on your symptoms, what the shoulder can do, and whether the tendon can be repaired again.

  • They usually stay. Dr. Raynor usually tries to reuse the same holes. If a new anchor will not hold there, he uses a larger anchor, and if that will not fit, he works around the old holes. Very rarely, the holes need to be filled with bone graft and the repair done later as a second operation, but that is very uncommon.

  • Often. A revision is repairing tissue that has already failed once, so Dr. Raynor frequently reinforces it with a collagen patch, a tissue graft, a fiber-based augment for the stitches, or, if the top of the cuff cannot be closed, a superior capsular reconstruction or the biceps tendon used as a graft.

  • The start is slower: the shoulder stays still for four weeks instead of two, the sling stays on for six weeks, and strengthening builds more gradually. Most people are doing what they want by about six months, though it can take longer.

  • Yes. Other surgeons refer revision repairs to him. Bring your operative report and images.

  • One or two injections over the course of treatment are reasonable. More can weaken the tendon and, before a repair, have been associated with a higher chance of needing another operation, so talk with Dr. Raynor before getting another one.

  • There are still options, from partial repair with reinforcement to superior capsular reconstruction and, for some older patients, a balloon spacer. See massive and irreparable rotator cuff tears.

  • Davey MS, et al. Bone Joint J. 2025;107-B(10):989-994. doi:10.1302/0301-620X.107B10.BJJ-2025-0160.R1 (315 studies, 60,505 repairs: retear 16.7%, revision 3.7%)

    Russell RD, et al. J Bone Joint Surg Am. 2014;96(4):265-271. doi:10.2106/JBJS.M.00265 (pain and function improved whether or not the repair healed; intact repairs stronger)

    Zhao J, et al. J Shoulder Elbow Surg. 2021;30(11):2660-2670. doi:10.1016/j.jse.2021.05.010 (risk factors for retear)

    Fan N, et al. J Shoulder Elbow Surg. 2022;31(3):656-667. doi:10.1016/j.jse.2021.10.026 (smoking and retear)

    Cimino AM, et al. Arthroscopy. 2020;36(8):2334-2341. doi:10.1016/j.arthro.2020.04.044 (injections and revision rate)

    Brochin RL, et al. J Shoulder Elbow Surg. 2020;29(3):624-633. doi:10.1016/j.jse.2019.06.023 (systematic review of revision repair, 22 studies)

    Desmoineaux P. Orthop Traumatol Surg Res. 2019;105(1S):S63-S73. doi:10.1016/j.otsr.2018.06.012 (review of failed rotator cuff repair)

    Keener JD, et al. J Bone Joint Surg Am. 2010;92(3):590-598. doi:10.2106/JBJS.I.00267 (revision arthroscopic repair: integrity and outcomes)

    MacLean IS, Brockmeier SF. Clin Sports Med. 2023;42(1):141-155. doi:10.1016/j.csm.2022.08.006 (review of failed and revision repair)

    Hohn EA, et al. J Shoulder Elbow Surg. 2018;27(5):816-823. doi:10.1016/j.jse.2017.09.026 (revision repair with tissue graft augmentation)

    Merolla G, et al. Int Orthop. 2025;49(6):1427-1438. doi:10.1007/s00264-025-06502-7 (graft augmentation in primary and revision repair)

Why patients choose Dr. Raynor for revision rotator cuff repair

  • Orthopaedic surgery residency at Vanderbilt and sports medicine fellowship at the Steadman Philippon Research Institute in Vail, Colorado

  • Board-certified orthopaedic surgeon; D Magazine Best Doctor every year since 2019

  • Team physician for the U.S. Ski and Snowboard Team, Highland Park High School, St. Mark's School of Texas, Ursuline Academy and The Hockaday School

  • Teaches arthroscopy at AANA Masters Courses and has reviewed for the American Journal of Sports Medicine since 2016

  • Rotator cuff repair is one of the operations he performs most often, and other surgeons refer large and revision repairs to him

  • Uses the full range of reinforcement and reconstruction options, so a revision can be matched to the tissue that is left

Make an appointment

Call (214) 265-3211 or send an appointment request and mention that you have had a rotator cuff repair that may have failed. Texas Orthopaedic Associates, a Division of OrthoLoneStar, 7115 Greenville Avenue, Suite 310, Dallas, TX 75231.

Written and medically reviewed by M. Brett Raynor, M.D., board-certified orthopaedic sports medicine surgeon. Last reviewed October 2026. General information for patients; it does not replace an examination, and your own surgical plan comes first.

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