As experience has been gained in the arthroscopic repair of small and moderate rotator cuff tears, there has been a natural progression toward the repair of larger tears.1–3 There is now considerable experience in the arthroscopic repair of these larger tears. The most significant advantage of an all-arthroscopic approach in the repair of large and massive rotator cuff tears is the elimination of deltoid morbidity that often occurs after open surgery.4–6 Many patients will not recover full function of the cuff despite attempts at repair, and so loss of deltoid function is an even more significant complication in this group. The larger the cuff tear (and the more extensile the surgical exposure), the greater the potential benefit of an arthroscopic repair.