With the deepening of the understanding of shoulder diseases, rotator cuff tear is well known as a common disease causing shoulder pain and activity limitation, and its treatment methods are becoming more and more diversified, arthroscopic repair and small incision open repair have achieved good results. However, huge rotator cuff injuries with a tear diameter of more than 75px are still a difficult problem in the treatment of rotator cuff injuries, which is not only difficult to operate, but also has a high re-tear rate after operation. Surgical method The patient was put under general anesthesia, lying on the healthy side with the body tilted back about 30°, and the affected shoulder was fixed in axial traction with 40° of abduction and 15° of forward flexion. The posterior approach and lateral approach were taken as observation approaches to observe whether the degree of rotator cuff tear was consistent with the preoperative diagnosis of MRI and color ultrasound; then the synovial membrane and the inferior border of the acromion were cleared in the subacromial space, and the anterior inferior was used to expose the rostral clavicular ligament, and then the rotator cuff stump was pulled back by piercing the suture after satisfactory laxation, to evaluate whether the rotator cuff could be repaired or not; if the rotator cuff stump could be pulled back to the greater tuberosity pedicle, then the pedicle pedicle and the rotator cuff stump would be further trimmed and freshly made, and then the rotator cuff stump near the surface of the joint was retracted. If the rotator cuff stump can be pulled back to the greater tuberosity footprint, the footprint and rotator cuff stump are further trimmed and freshened, and two internal anchors are inserted in the footprint area near the articular surface, and the sutures are passed through the rotator cuff stump at a distance of about 37.5 px and tied sequentially. 1-2 external anchors are used to compress the rotator cuff stump over the greater tuberosity footprint area. The rotator cuff stump was knotted again, and the rotator cuff stump was pressed over the greater tuberosity foot impression area); the acromion was routinely shaped, and the subacromion surface bone was polished smooth and leveled. Each arthroscopic entrance was closed sequentially (Figs. 1-5). Fig. 1 Preoperative activity Fig. 2 Preoperative MRI Fig. 3 Intraoperative arthroscopic image Fig. 4 Postoperative X-ray Fig. 5 Postoperative activity in six months Postoperative treatment Postoperative upper extremity suspension immobilization braking for about 6 weeks (in some cases, due to the severe rotator cuff contracture, the rotator cuff tension was high after suture, and it was changed to use abduction support to fixate it), during the period of braking, the affected shoulder was subjected to the pendulum-like passive functional exercise, and after 6 weeks, the active functional exercise of shoulder was gradually carried out, and the shoulder was basically restored to normal joint activity, and the normal joint movement was restored to normal joint movement in 6 months, and the shoulder was gradually restored to the normal joint activity in 6 months. Normal joint activities were basically resumed in 4-6 months after the operation, and general physical exercises could be carried out in 6 months, and the patients’ shoulder joint function was assessed by Constant-Merly score and UCLA score in 12 months after the operation. Rotator cuff injury is a common age-related degenerative shoulder disorder. Through a large number of autopsies, the rotator cuff was found to be divided into 5 layers, of which layers 2 and 3 were the main tendinous tissues. According to the degree of tearing of the rotator cuff, it is categorized into partial tearing and total tearing. Partial tears are divided into upper surface tears (i.e., acromion surface tears), lower surface tears (i.e., articular surface tears), and intratendinous tears; full rotator cuff tears are divided into crescent tears, U-shaped tears, L-shaped tears, and large rotator cuff tears (>5 cm) according to their shapes. Conservative treatment, incisional surgery, and arthroscopic rotator cuff repair are used to treat rotator cuff injuries. Conservative treatment includes oral NSAID drugs, physical therapy, subacromial injection of corticosteroids, etc. Conservative treatment can relieve pain and even restore part of the mobility of the shoulder joint, but it has no obvious effect on the loss of muscle strength, and the long-term efficacy is poor. Incision surgery, especially small incision rotator cuff repair is still a good choice for rotator cuff injury. With the advancement and improvement of arthroscopic instruments and techniques, total arthroscopic rotator cuff repair has gradually become popular and gained good efficacy. Although there is some controversy whether to repair the rotator cuff in single row or double row, there is more and more evidence showing that the double row fixation technique can significantly reduce the re-tear rate of the rotator cuff and increase the contact area between the tendon and bone, which is favorable to tendon-bone healing. Arthroscopic surgery for giant rotator cuff injuries is difficult to operate, and the retear rate of the rotator cuff using single-row anchor nailing suture is very high, so nowadays most of them tend to apply double-row anchor nailing fixation, and the literature reports in recent years have shown that the satisfactory rate of repairing giant rotator cuff injuries using double-row anchor nailing is close to the result of incision surgery. For giant rotator cuff tears that cannot be pulled back to the greater tuberosity of the humerus, partial repair or application of biopatch can be used. The application of side-to-side sutures to reduce the rotator cuff defect has achieved good short-term results. The application of a biopatch to repair a retracted giant rotator cuff tear has also yielded good short-term results.