Background open approach has been considered for years the good standard for rotator cuff repairs. Nevertheless, the rate of tendon-to-bone healing, and that of cuff re-tear, still remains unclear At a mean follow-up of 31 months, twenty three open repairs of massive rotator cuff tears yielded good and excellent clinical results despite a retear rate of 41%. Patients with a retear had improvement over the preoperative state, but those with a structurally intact repair had a substantially better result. the purposes of this study were to determine the clinical and structural long-term results after open repair of massive rotator cuff tears in patients who had been examined with the same, standardized methodology at follow up evaluation and to identify additional problems and the functional outcome and rate of re-tears after-open repair of large and massive tears of RCT Methods: Between 2015 and 2018, 25 shoulders (25 patients) with a mean age of 53 years (range, 35-71) and a large or massive cuff tear were repaired with a open procedure. At a minimum of 31 months postoperatively ( 23 patients) underwent functional evaluation and US investigation of cuff integrity. inclusion criteria at the time of surgery 25 patients, 10 men and 15 women, attended a follow-up clinic at a mean of 31 months(14 to 48). Two patients were lost to follow up and were not included in the analysis. Exclusion criteria : previous operation, fracture or infection on the affected shoulder, or moderate to severe gleno humeral osteoarthritis. The indication for surgery was in all cases a painful shoulder with ongoing functional impairment after an unsuccessful period of physical therapy of at least 3 months. At a mean follow-up interval of 31 months, twenty-three of the patients returned for a review and were examined clinically, radiographically, and evaluated through using of UCLA Shoulder Score (the University of California at Los Angeles Shoulder Score). and with ultrasound imaging with use of a methodology identical to that used at 31 months Results: eighteen of the twenty-three patients remained very satisfied or satisfied with the result. The mean subjective shoulder value was 78%. The mean UCLA score improved from from 12.2 before operation to 29.8 postoperative, The retear rate was 41% but not affect the significant improvement of the patient post operative , infection rate was just in one case superficial wound infection ), two patient with moderate satisfaction and two patient unimproved post operative )) Discussion: Our results suggest that large and massive rotator cuff tears treated with open technique using with ( 5-mm metal bone anchors-G4 Superanchors(DePuyMitek, Raynham, MA) with double-loaded No. 2 Ethibond sutures) have a very satisfactory clinical outcome, despite a significant re-tear rate. Conclusion: open repair of massive RCTs may result in a good clinical outcome and significant improvement and return to daily activity in a number of patients despite a high rate of recurrent or residual tears.