Early surgical repair of rotator cuff tears with a partial anterior acromionectomy is recommended as a means of minimizing a progression of symptoms and findings. It was more important to achieve adequate tension in the cuff tissues than to obtain a water-tight closure. Even patients with old complete tears may obtain good results from reconstruction of the rotator cuff. However, merely closing a rotator cuff tear will not permit a good functional result if the ability of the muscles to contract adequately is lost forever. This group of patients rarely achieves full restoration of muscle strength in their operated shoulders, primarily due to muscle atrophy. In shoulders previously operated on, functional results were not as good as in those cases operated on for the first time. Avoidance of interposed soft tissue grafts and restoration of a direct continuity of viable rotator cuff tissue to its bony insertion are recommended whenever possible, to achieve the optimum functional result. In those patients with arthritis of the glenohumeral joint or permanent long-standing nonfunctional rotator cuff muscle, the results of reconstruction were poor. A carefully supervised postoperative rehabilitation program is essential for optimum results.