I had a rotator cuff repair that went south in the first six weeks. What causes a repair like this to tear again?

There are many factors to consider when evaluating a rotator cuff repair failure. The immediate repair strength is one concern. Surgeons are careful to use suturing techniques known to have high success rates. But the sutures can still saw through the tendon or the tendon can give way after cyclical loading (repetitive motions).

Patients are encouraged to follow post-op instructions carefully. The idea is to avoid having suture breakage, pullout, slippage, or tendon tears. Too much load, too soon can lead to repair failure.

For some patients, bone quality is an important factor as well. Brittle or soft bones in older adults may not hold the sutures in place during the healing phase.

Your surgeon may be able to answer this question more specifically once the tendon repair is examined. The surgeon will look at the location of the failure (e.g., at the suture to bone interface, suture to tendon interface, or tendon to bone attachment). Poor tendon quality can have a negative effect on a rotator cuff repair.