The incidence of massive rotator cuff tear is quite high in the elderly patients. It can result in pain and shoulder dysfunction, and reduce their quality of life greatly. Massive rotator cuff tear usually accompanies with tendon retraction, degeneration, muscle atrophy, and fat infiltration. What’s more, because the elderly patients commonly have severe osteoporosis, it further makes the repair more difficult and with high post-operative tear rate. The article reviewed the recent progress on the clinical efficacy and prognosis of 5 surgical strategies in the treatment, that is, debridement and decompression, complete repair, partial repair, patch repair and reconstruction of shoulder joint capsule, in order to provide theoretical foundation for the surgeon’s decision making.