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Failure of structural healing is not infrequent after rotator cuff repair and often is not associated with clinical outcome. The goals of this study are to describe outcomes in a cohort of patients with a failed rotator cuff repair and to evaluate factors associated with clinical outcome.This was a retrospective study of all patients with failure of structural integrity after rotator cuff surgical repair. A threshold American Shoulder and Elbow Surgeons (ASES) score of 80 points was used to allocate patients into either the successful (≥80 points; Group 1) or unsuccessful (<80 points; Group 2) cohorts. Demographics, patient-centered instruments for shoulder function, radiographic parameters, and shoulder motion were compared between groups.On the basis of the postoperative ASES score, thirty-three patients (54.1%) were included in Group 1 and twenty-eight patients (45.9%) were included in Group 2. Fifteen patients (53.6%) in Group 2 reported a labor-intensive occupation compared with two patients (6.1%) in Group 1 (p < 0.001). Multiple regression analysis demonstrated that labor-intensive occupation (odds ratio [OR], 202.3; p = 0.026), preoperative Simple Shoulder Test (SST) score (OR, 0.50; p = 0.028), and preoperative external rotation (OR, 0.91; p = 0.027) were associated with inclusion in Group 2. Age and other demographic variables, including sex, dominant-sided surgery, and medical comorbidities, were similar for the groups.Successful outcomes were achieved in 54% of patients with failed rotator cuff repair. Those who self-identified their occupation as being labor-intensive represented a special group of patients who are at high risk for a poor outcome after a failed rotator cuff repair.Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.This article was reviewed by the Editor-in-Chief and one Deputy Editor, and it underwent blinded review by two or more outside experts. The Deputy Editor reviewed each revision of the article, and it underwent a final review by the Editor-in-Chief prior to publication. Final corrections and clarifications occurred during one or more exchanges between the author(s) and copyeditors.