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I had a rotator cuff tear that was repaired two years ago. Today I have pain as bad as when it originally tore and I'm limited with what I can do at work, which may cost me my job. I'm trying to decide if I should just learn to live with it or go have another operation. Neither option thrills me.

Believe it or not, many people face this same decision. Tendons fail to heal after rotator cuff repair more often than anyone would like. So your question is very relevant -- if you've had a rotator cuff tear repaired but it didn't heal and/or it tore again, should you go for a second (revision) surgery to repair the recurrent tear? What are the chances the second surgery will work? There aren't very many reports out there to help guide patients and surgeons with this difficult decision. The results of a recent study from the Shoulder and Elbow Department of Orthopaedic Surgery at Washington University in St. Louis provide some very helpful information. In that study, 21 patients with failed rotator cuff surgery (either because of failure of tendon healing or due to a retear of the previously repaired tendon) had a second operation to try and correct the problem. No one rushed into the second surgery. They all tried at least six-months of rehab after the first repair. But persistent pain and loss of motion and function sent them back to the surgeon for help. The exact revision surgery varied from patient-to-patient depending on what the surgeon found when looking inside the shoulder. And there was a wide range of problems present: biceps tendons torn fully and retracted too far to repair, cartilage holes and tears, complete tears of one or more tendons, degenerative changes in other tendons, irregular bone edges. Everything was carefully repaired or reconstructed and the patients all went back to rehab once again. And the results? Well, almost everyone did get pain relief and improved motion and function. Most of the patients improved enough to be able to return to work, play a sport if so desired, and resume daily activities. But less than half (48 per cent) had an intact repair as seen on ultrasound. Five of the 21 patients (about 25 per cent of the group) considered themselves disabled. With ongoing pain, they just weren't able to even do their daily activities. The surgeons found that single-tendon repairs were more likely to be successful than multiple-tendon repairs. In fact, statistical analysis showed that 70 per cent of the single-tendon repairs were in good shape. Only 27 per cent of the multiple tendon repairs made it. Intact tendons did improve shoulder strength. The older the patient, the greater the chance of a poor outcome. So, the final decision in your case will be made based on what the surgeon finds during a diagnostic arthroscopic exam. Your age, the size of the tear, and extent of overall damage or degeneration of the shoulder and surrounding soft tissues will all factor into what can be done.

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