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Outcomes following revision surgery for failed rotator cuff repairs are far less predictable than and are associated with decreased patient satisfaction compared with primary repairs. Extracellular matrix augmentation (ECM) may improve the biologic potential for healing during revision repair. The authors examined clinical outcomes and healing rates based on postoperative imaging of patients who underwent revision open rotator cuff repair with an ECM patch for symptomatic recurrent rotator cuff tear. Twenty-four (77%) of 31 patients with a mean follow-up of 50 months (range, 30-112 months) completed post-revision surgery outcome questionnaires at a mean of 5.3 years after revision surgery, and 16 patients (67%) underwent a physical examination and repeat imaging (ultrasound or magnetic resonance imaging) at a mean of 4.2 years after revision surgery. Ten (63%) of those 16 patients were found to have failed revision rotator cuff repair on imaging, with American Shoulder and Elbow Surgeons (ASES) outcome measures that were significantly (P=.04) better in patients with confirmed intact repairs than those with confirmed failed revision repair. Outcome measures for all patients (n=24) included a mean ASES score of 67.2 (SD, 27.9) and a mean Single Assessment Numeric Evaluation (SANE) score of 66.9 (SD, 26.0). Based on these scores, excellent results were achieved in 24% of patients, good in 13%, fair in 21%, and poor in 42%. Results of this investigation demonstrated that augmentation of revision rotator cuff repair with an ECM patch through an open approach showed no significant improvement in outcomes when compared to historical reports without augmentation.