Rotator cuff pathology is one of the most common reasons for patients to seek orthopaedic consultation. Although in many cases these issues can be resolved with proper conservative management, many of these patients benefit from surgical treatment. The goal of this instructional course lecture is to identify factors that can potentially lead to worse outcomes following repair, describe the history and techniques behind transosseous anchorless repairs, discuss subscapularis tears and their management, and to analyze the most current data regarding double-row rotator cuff repairs. Rotator cuff tears managed surgically have been proven to provide significant pain relief and improved function; however, surgical intervention in patients with significant risk factors for failure can lead to substantial disability for the patient.