Almost 100 years have passed since the first report of rotator cuff repair in 1898 by W. Müller. Even now new operative techniques are being developed. Various solutions for difficult extended forms of rotator cuff lesions are available besides the closed and semi-closed arthroscopic techniques. Anatomical reconstructive procedures such as local or distant tendon transfer compete with extra-anatomical procedures such as simple debridement, equatorial partial reconstruction or replacement with a delta flap. Hemiarthroplasty of the shoulder has proven to be more and more the treatment of choice in cases of inoperable rotator cuff defects with painful arthropathy. The euphoria caused by complicated reconstructive methods for massive tears has subsided due to an awareness that loss of function is inevitable in chronic degenerative tears with muscle atrophy. Reconstruction should be coordinated step by step with the operative procedure as well as adapted to the biological situation. It should definitely not be forced at any price using an algorithm for a rotator cuff tear operation, the best operative method must be selected by clinical, radiological and intraoperative criteria. The situation is completely different for an acute traumatic rotator cuff tear. Every effort should be made to perform early anatomic reconstruction in a young patient, as the function of the rotator cuff is of great importance in the working world. In contrast to degenerative changes of the rotator cuff tendon, large ruptures can be treated successfully if early immediate repair is performed. The long head of the biceps tendon plays a special role in combination with a rotator cuff tear. The concomitant lesions of the long head of biceps should not to be over-looked when repairing the rotator cuff tear. Until now, a special form of rotator cuff pathology has not received much attention--the so-called interval lesion. It is the forerunner of the rotator cuff tear. The interval lesion is a partial tear of the ligamentous structures between the supraspinatus and subscapularis tendon and leads to damage of the long head of the biceps. The interval lesion can only be diagnosed by arthroscopy or open exploration of the rotator interval.