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Results of operative treatment of failed rotator cuff repair are inferior to those of primary repair. A high percentage of patients have good pain relief, but improvements in range of motion and function are less satisfactory. Therefore, most patients with failed repairs should be treated nonoperatively. The etiology of failure is often multifactorial. Technical factors associated with failure are avoidable. These include radical or lateral acromionectomy, inadequate subacromial decompression, unaddressed acromioclavicular arthrosis, insufficient tendon mobilization, rotator cuff repair under undue tension, and inappropriate rehabilitation. Positive prognostic factors for a successful reoperation include a functional deltoid, an intact lateral acromion, preoperative elevation above the horizontal, good-quality tissue, and a history of one previous attempt at repair. As the best chance for a successful result is at the time of primary repair, attention to meticulous technique is mandatory.