[Objective] To introduce the surgical technique and preliminary clinical results of arthroscopic superior fulcrum reconstruction (SFR) for irreparable massive rotator cuff tears ( IMRCT).[Methods] Form January 2020 to June 2022, 18 patients underwent arthroscopic superior fulcrum reconstruction for irreparable massive rotator cuff tears. A thorough arthroscopic examination and clean firstly, the rotator cuff stump and synovial bursa was debrided, and the long head of biceps tendon was cut or fixed according to the specific situation.The ipsilateral peroneus longus tendon was harvested 13-15cm in longth and 2-3mm in diameter, and was divided into two bundles ,which were woven with tendon lines.The bone tunnels were established in the glenoid side and the humeral head side, respectively. Then the tendon was pulled through the bone tunnels by the PDS line, and finally the tendon was knotted in the lateral side of the proximal humerus.[Results]The arthroscopic operation was performed successfully in all the 18 patients without serious complications, such as nerve and vascular injury.With time of follow-up lasted for 12~24 months. At the last follow-up, the VAS, CMS,UCLA and ASES scores significantly improved compared with preoperative scores (P<0.05). Radiographically, the acromiohumeral distance (AHD) significantly increased postoperatively compared with that preoperatively (P<0.05) .All the graft had good appearance on images.[Conclusions ]This arthroscopic superior fulcrum reconstruction (SFR) is feasible technique for irreparable massive rotator cuff tears and get satisfactory clinical outcomes in short-term.