The massive rotator cuff tears resulting in sever shoulder pain with difficult in movement, this tears occurs due to chronic degeneration in elderly or direct injury and/ or shoulder dislocation or proximal humerus fractures as in athletics.The diagnosis of these tears depends on clinical examinations or with MRI which considers as the most accurate method.The Massive rotator cuff tear are defined as one in which the major tear diameter was greater than 5 cm. Massive rotator cuff tears generally involve complete rupture of the supraspinatus tendon and partial or complete rupture of one or more of the subscapularis, infraspinatus, and teres minor tendon.The management of these tears summarized on -if the conservative methods are failed- open repair or arthroscopic and/or tendon transfer ,the cases that associated with shoulder osteoarthritis can treated by reversed total shoulder, there is a new method for treatment by allograft patches.Finally, you did not expect the result of surgical treatment of these tears.