Twenty patients who had a massive tear (greater than five centimeters) of the rotator cuff that was not amenable to direct tendon-to-bone or tendon-to-tendon repair had reconstruction consisting of transfer of the subscapularis tendon in conjunction with subacromial decompression. At a mean of thirty months (range, twenty-three to seventy months) after the operation, seventeen of the patients were satisfied with the result. Nineteen patients reported a decrease in pain compared with preoperatively. However, nine patients had weakness and discomfort with prolonged or repetitive overhead activities, and two patients had lost active elevation of the shoulder despite substantial relief of pain.Subscapularis transfer is a useful adjunct in the operative treatment of massive tears of the rotator cuff; it facilitates the closure of larger defects that are not amenable to simpler, more traditional reconstructive techniques. However, because there is a risk of the procedure adversely affecting active elevation of the shoulder, it should be used with caution in patients who have full functional elevation preoperatively.