A significant number of rotator cuff defects are brought to light following a first-time dislocation in older patients. Recurrence in this group of patients is low; however, standard anterior repairs may be employed effectively in such situations. Neurologic and vascular injuries, although infrequent, should be carefully ruled out as accompanying the initial injury. Knowledge of these facts will allow a better appreciation of the pathology associated with the anterior dislocation in the older patient. From this, more confident recommendations may be made regarding management of these difficult problems.