This article reports the results of treatment for irreparable tears of the rotator cuff with a new procedure that we have termed a tuberoplasty. The tuberoplasty procedure involves removal of exostoses on the humerus followed by reshaping of the greater tuberosity to create a smooth, congruent acromiohumeral articulation. The coracoacromial ligament is preserved, and an acromioplasty is not performed. Twenty patients underwent this procedure with a minimum 27-month follow-up. All patients had significant disabling pain and weakness preoperatively. On the basis of the modified UCLA rating scale, the overall score increased from 9.3 to 27.7, with 12 excellent results, 6 good results, and 1 fair result (95% satisfactory). Pain relief was most dramatic, with 13 patients (68%) completely pain-free. All patients were able to perform activities of daily living, and 9 of 11 who were employed preoperatively returned to work. All patients had residual weakness in external rotation. There were no poor results and no complications.