Treatment options for Failed Rotator Cuff Surgery

Ross A. Hauser, MD; Danielle R. Steilen-Matias, MMS, PA-C

Treatment options for Failed Rotator Cuff Surgery

There are many people who have had very successful rotator cuff repair surgeries. These are typically not the people that we see in our office. We see the people after surgery who have been diagnosed or classified as a “failed rotator cuff surgery patient.” In this article, we will explore non-surgical options for the problems of continued pain and loss of function following rotator cuff surgery.

We will often hear stories like this, maybe it is like yours:

I was told before surgery that there was a chance the surgery would not help.

I had the surgery. I had a very long rehab. I went back to my surgeon because the pain in my surgical shoulder was getting much worse. My shoulder clicks, pops, and sometimes it gets stuck mid-motion. I was told before surgery that there was a chance the surgery would not help. I had the surgery anyway. It did not help. My shoulder is now worse. My surgeon wants to send me to get an MRI so we can decide if a second rotator cuff repair surgery may help or if I should get a shoulder replacement. I have decided against any surgery, too much pain, too much rehab, too much everything. If you can help me with your treatments I would be interested but I can also just live with this.

None of them could explain why my surgeries had failed.

I have had two surgeries, both failed. I had a team of surgeons. None of them could explain why my surgeries had failed. My options now are the occasional cortisone injection and more physical therapy. My surgeons want to take a wait-and-see approach before making any further recommendations. Can you help me?

5 surgeries

I have had three rotator cuff surgeries on my left shoulder and two on my right shoulder. Despite these repairs, both shoulders have progressed to full-thickness tears. Now I am told my only option is total reverse shoulder replacement.

Why did the surgery fail and how do you treat it?

Let’s point out again that many people have successful rotator cuff surgeries. Many people have success after a second or third surgery goes in and adjusts or fixes the first surgery. Surgery can also cause more harm than good. Recovery time is often long and presents its own complications.

 In this section, we will highlight two recent studies. The learning points are:

Is there a good time to have a revision rotator cuff surgery? Soon after surgery, wait for a while?

An October 2020 study (1) examined when was the best time for a patient to get a revision rotator cuff surgery.

It can be said, neither group had the best of outcomes. However, for some people, the revision surgery was very successful for them.

The Rotator Cuff Bridge Collapse

If you are reading this article it is unlikely that you need a long description of the rotator cuff “bridge” technique. This surgery is appealing to the younger, more active person or those who do physically demanding work because it has demonstrated superior clinical results and lower failure rates compared to other rotator cuff surgical techniques. There is a knotless version and a knot-tying suture-bridge technique. Numerous ongoing studies compare the two. (2) In the bridge technique, cadaver tissue is used to repair complete ruptures or rotator cuff tears where the tissue cannot be repaired.

In February 2019, surgeons at the University of Cincinnati Medical Center and the University of Alexandria Medical Center in Egypt, combined their observations in examining Type 2 retears after arthroscopic single-row, double-row, and suture bridge rotator cuff repair. The research appears in the European Journal of Orthopaedic Surgery & Traumatology. (3)

In this study, the researchers examined data from 14 published studies and 260 rotator cuff re-tears. Re-tears were classified into type 1 (failure at the tendon-bone interface) and type 2 (medial cuff failure).

Conclusion: “this study suggests that double-row and suture bridge techniques increase the risk of medial cuff failure. Modifications in surgical techniques in both double-row and suture bridge repairs can help decrease that risk.”

So in agreement with the idea that the “bridge repair” is better is the above study.

Bridge surgery is the most effective?

Here is a 2019 study in the journal Scientific Reports. (4) It examined 1815 shoulders that had a rotator cuff repair surgery. What the researchers were looking for was retear rate and range of motion scores (forward flexion and external rotation). Here are the findings:

In this third study, there is an agreement that one surgery is not vastly superior to the other. Bridge repair is just one of many options.

“Although numerous biomechanical and clinical studies comparing different rotator cuff repair techniques have been published in the past decade, none has achieved universal acceptance.”

In this September 2019 study in the Orthopaedic Journal of Sports Medicine (5) and from the Hospital Italiano de Buenos Aires, Hospital for Special Surgery, New York,  and Rush University Medical Center, Chicago, the following points are made:

Simply, depending on the surgeon, you can get many different types of surgery because there is no conclusive evidence that one surgery is vastly superior to another.

In this illustration, we show typical sites injected during a Prolotherapy treatment. The point is not to isolate a single problem but to stabilize the shoulder surgery as a whole.

taion, the brachial plexus, the coracobrachialis, the biceps bracii muscle, the axillary artery, the pectoralis minor muscle.

Here we see the areas including the transverse humeral ligament, the coracoid process, the subscapularis muscle and tendon insertion, the brachial plexus, the coracobrachialis, the biceps bracii muscle, the axillary artery, the pectoralis minor muscle.

Prolotherapy as a treatment option for failed rotator cuff surgery

Prolotherapy is an in-office injection treatment that research and medical studies have shown to be an effective, trustworthy, reliable alternative to surgical and non-effective conservative care treatments. In our opinion, based on extensive research and clinical results, Prolotherapy is superior to many other treatments in relieving the problems of chronic joint and spine pain and, most importantly, in getting people back to a happy and active lifestyle. For extensive medical citations and research please see our comprehensive Prolotherapy information page.

In our more than 27 years of experience in helping people post-surgery, we have seen many rotator cuff failures. To be fair, failures can be described in many different ways. Most commonly, failure is seen when the shoulder was worse off after the surgery or the surgery did not achieve all the patient’s goals but still provided some pain relief and some function. We have seen many patients respond positively.

Prolotherapy research

In February 2019, (6) Sports specialist and orthopedic surgeons in Turkey published their findings on the effectiveness of Prolotherapy in helping the patient with failed rotator cuff repair surgery. This research was published in the Turkish Journal of Physical Medicine and Rehabilitation.

The intra-group comparison showed that the patients achieved significant improvements at all time points, compared to baseline as measured by VAS, SPADI, WORC index, and shoulder range of motion. Twelve patients (80%) reported excellent or good outcomes.

CONCLUSION: “Our study results show that prolotherapy is effective in the treatment of patients with failed rotator cuff repair surgery with significant improvements in the shoulder functions and pain relief.”

These results are in general agreement with what we have seen in our clinic.

Bone Marrow Stem Cell Therapy and Platelet Rich Plasma Injections after surgery

In the video below Prolotherapy and Platelet Rich Plasma injections are explained. In combination, we call this PRP Prolotherapy. In Platelet Rich Plasma injections your blood is used, by way of its platelets, to create concentrated platelet solutions rich in healing and regenerative factors.

Stem cell therapy is reserved for more advanced degenerative changes in the shoulder. Treatment utilizing stem cells for rotator cuff as a first-line treatment is something that we usually do not offer because of expense and the ability of Prolotherapy and PRP to do a good job of healing. We do discuss this with all patients prior to treatment.

Our ultimate goal with all forms of Prolotherapy is to get the patients back to doing the things that they want to do without pain and without surgery.

In this video, a general demonstration of Prolotherapy and PRP treatment is given for a patient with repeated shoulder dislocations

Danielle R. Steilen-Matias, MMS, PA-C narrates the video and is the practitioner giving the treatment:

Prolotherapy is an injection technique utilizing simple sugar or dextrose.

The problem of post-surgical nerve pain

In this video, Danielle R. Steilen-Matias, MMS, PA-C discusses treating a patient with nerve pain following shoulder surgery.

Video blurbs:

We have seen many people with many problems following their rotator cuff surgeries. If you have questions about your Rotator Cuff problems You can get help and information from our Caring Medical staff.


1 Lee S, Park I, Kim MS, Shin SJ. Clinical differences between patients with early and late revision surgery for symptomatic failed arthroscopic rotator cuff repair. Knee Surg Sports Traumatol Arthrosc. 2020 Oct 23. doi: 10.1007/s00167-020-06333-6. Epub ahead of print. PMID: 33095333. [Google Scholar]
2 Comparison of Repair Integrity and Functional Outcomes Between Knot-tying and Knotless Suture-bridge Arthroscopic Rotator Cuff Repair: a Prospective Randomized Clinical Trial. Identifier: NCT03982108
3 Bedeir YH, Schumaier AP, Abu-Sheasha G, Grawe BM. Type 2 retear after arthroscopic single-row, double-row and suture bridge rotator cuff repair: a systematic review. European Journal of Orthopaedic Surgery & Traumatology. 2019 Feb 4;29(2):373-82. [Google Scholar]
4 Xu B, Chen L, Zou J, Gu Y, Hao L, Peng K. The clinical effect of arthroscopic rotator cuff repair techniques: A network meta-analysis and systematic review. Scientific reports. 2019 Mar 11;9(1):1-1. [Google Scholar]
5 Rossi LA, Rodeo SA, Chahla J, Ranalletta M. Current Concepts in Rotator Cuff Repair Techniques: Biomechanical, Functional, and Structural Outcomes. Orthopaedic journal of sports medicine. 2019 Sep 20;7(9):2325967119868674. [Google Scholar]
6 Akpancar S, Örsçelik A, Seven MM, Koca K. The effectiveness of prolotherapy on failed rotator cuff repair surgery. Turkish Journal of Physical Medicine and Rehabilitation. 2019 Jun;65(4):394. [Google Scholar]


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