OBJECTIVE To analyse the current scientific evidence regarding the natural history of the clinical and anatomical progression of rotator cuff tears. METHODS A broad systematic review of the literature (PubMed database through January 2014) which was guided, conducted and reported according to PRISMA criteria. This article focuses on the rotator cuff tears. Articles had to meet an inclusion criteria. The methodological quality of each study was individually assessed using a recently developed general assessment tool AMQPP (assessing the methodological quality of published papers). RESULTS Seven articles dealing with rotator cuff tears were included, one of them was a high-quality study. Three papers assessed the natural history and the natural course of rotator cuff rupture directly. The other studies indirectly assessed the natural history with reports on non-operative and operative therapy trends. All of these articles had been published in four different top medical journals according to 2013 ranking. We found no articles which clearly referred to the role of regression to the mean of rotator cuff tears. CONCLUSIONS The development of symptoms and anatomical deterioration are often directly correlated. Spontaneous recovery to normal levels of function has been successfully achieved, and standardised non-operative treatment programmes are an effective alternative to surgery for many patients. Follow-up is necessary to avoid irreparable stage. However, surgery is still favoured by young active people and highly professional persons who need to get fit in a short period of time. Further research is still necessary. The AMQPP score system is simple and reliable. It works as a quick quality-checking tool which helps researchers to identify the key points in each paper and reach a decision regarding the eligibility of the paper more easily.