Inclusion Criteria:  Large to massive rotator cuff tear (with or without subscapularis tear) that may possibly be irreparable without the use of graft materials (confirmed intra-operatively) Either primary tear or re-tear after previous repair Radiographic evidence of Hamada stage 1-3, with or without Samilson & Prieto mild osteoarthritis (<3mm inferior osteophyte)  Exclusion Criteria:  Primary glenohumeral osteoarthritis: radiographic evidence of Samilson & Prieto classification moderate or greater Cuff tear arthropathy (CTA): radiographic evidence of Hamada stage 4 or above Inflammatory joint disease of the shoulder (e.g. rheumatoid arthritis) Medical issues precluding surgery Unwilling or unable to complete study outcomes Worker's Compensation Claim or litigation