Paul Sethi, an internationally renowned sports and shoulder surgeon, joins Vani Sabesan, a shoulder and elbow specialist, and Brian Waterman, chief of sports medicine. They dive into the complexities of diagnosing and managing acute on chronic massive rotator cuff tears. Key topics include the significance of imaging, particularly MRI and X-rays, to assess rotator cuff conditions, and surgical strategies for repair. The conversation emphasizes personalized treatment options, intraoperative techniques, and approaches to optimize recovery for active patients.