Recurrent defects of the rotator cuff still represent the most common complication after rotator cuff repair. The etiology is multifactorial; however, predominantly biological determinants seem to influence the structural outcome. Basically, recurrent defects due to non-healing of the rotator cuff tendons have to be distinguished from true re-ruptures, which occur after primary successful osteofibroblastic integration. Different modes of failure are responsible for recurrent defects of the rotator cuff. The management of recurrent defects depends on the clinical symptoms of the patient, the objective function of the shoulder and the pathomorphological changes of the rotator cuff and the shoulder joint itself. Beside a skillful neglect and/or conservative management, arthroscopic revision of failed cuff repairs appears to be a promising procedure. Irreparable tears can be managed using extraanatomic tendon transfer (latissimus dorsi or pectoralis major transfer) or shoulder replacement procedures (reverse prosthesis) depending on the functional symptoms of the patient. The results after re-reconstruction or open revision using tendon transfers are inferior compared to primary intervention.