1. The results of operation in sixty-three patients with rupture of the rotator cuff of the shoulder have been reviewed.

2. In seventeen patients the classical delto-pectoral route was found to give poor access and mediocre results.

3. In forty-six patients a superior approach along the supraspinatus fossa and through the divided acromion process was found to give excellent access and to permit lateral advancement of the supraspinatus muscle in order to enable wide gaps to be closed. With this improved surgical access the proportion of good results has been doubled.

4. It is suggested that when a case of rupture of the cuff, confirmed by arthrography, fails to respond to physiotherapy, operative repair should be undertaken.