Massive tears of the rotator cuff are often difficult to repair due to a lack of tendon. The use of synthetic patch materials (Gore-Tex ePTFE (W.L. Gore, Flagstaff, AZ)) as a tendon substitute is one solution to bridge tendon defects in otherwise irreparable tears. The long-term (9.7 y) outcomes of 5 patients having had a synthetic patch repair in our institution are promising. The synthetic patch repair of these patients was performed as an open surgery. Recently, the senior author (G.A.C.M.) has developed a method of performing these repairs arthroscopically using a tension-band, knotless anchor technique. This study describes the arthroscopic technique used to repair an otherwise irreparable rotator cuff tear using ePTFE synthetic patches.