Table 2.

Management options after failed rotator cuff repair.

Management	Indications	Aims and principles
Conservative	Irreparable tear Low demand patients	Physiotherapy to optimise strength of residual rotator cuff, deltoid and periscapular muscles
Revision rotator cuff repair	Adequate tendon length High demand patients Male	Correct reversible risk factors Adequate visualisation Tendon mobilisation Tension free repair Strong biomechanical fixation
Superior capsular reconstruction	Male High demand patient Functional subscapularis Preserved acromio-humeral distance Lower BMI Preserved forward flexion	Use of stiff thick graft Restore posterior continuity to infraspinatus tendon to restore force couple
Tendon transfer	Active patient Pain Functional loss of strength	Restore shoulder kinematics and improve function, strength and pain Use of expendable donor muscle-tendon unit Donor and recipient to have similar excursion and tension Donor and recipient to have similar line of pull Donor muscle to replace single function of recipient muscle
Reverse shoulder arthroplasty	Cuff tear arthropathy Pseudoparalysis of the shoulder	Restore pain free functional motion