Trauma is often involved in the history given at presentation but the main underlying problem in patients with Rotator Cuff tearing is degenerative change.

There has been a transition in techniques for repair of tendon tears from majority open repairs in the 1970–80s to minideltoid repairs in the 1980–90s. In the last 10–15 years there has been a strong drive to evolve the repair to an all arthroscopic technique.

With this evolution has come new equipment, implants and steep learning curves for surgeons at significant increase in cost to the health system with no clear improvement in long term outcome.

The ability to obtain repair of a degenerate tendon to bone remains the challenge and poses a difficult problem for all orthopaedic surgeons.