ObjectiveTo investigate the negative prognostic factors in the management of massive rotator cuff tears.DesignRetrospective nonrandomized study.SettingFaculty Practice associated with a major orthopedic teaching hospital.Patients108 patients who were treated for massive rotator cuff tears were evaluated for an average of 3.2 years posttreatment. There were 58 females and 50 males, with a mean age of 61.3 years.Interventions40 patients underwent conservative nonsurgical management (Group 1), 32 patients underwent arthroscopic debridement (Group 2), and 36 patients underwent primary repair of the rotator cuff (Group 3).Main Outcome MeasuresA detailed Shoulder Rating Questionnaire was filled out by patients pretreatment and minimal 2 years posttreatment.ResultsOverall, Group 1 had 65% excellent or good outcomes, Group 2 had 81%, and Group 3 had 86%. The subgroup of patients in Group 1 who had cortisone injections had a 75% success rate.ConclusionsNegative prognostic factors evaluated are presence of glenohumeral arthritis, decreased passive range of motion, superior migration of the humeral head, presence of atrophy, and external rotation/abduction strength less than 3. The presence of 3 or more of these negative prognostic factors are correlated with poor outcomes in the treatment of massive rotator cuff tears.