Background: Rotator cuff tears are among the most common causes of shoulder pain and functional disability in adults. Surgical repair is indicated in symptomatic full-thickness and selected partial-thickness tears that fail conservative management. Both arthroscopic and open repair techniques are widely practiced; however, controversy persists regarding their comparative clinical outcomes, complication rates, and functional recovery. Aim: To compare the functional and clinical outcomes of arthroscopic repair versus open repair in patients with rotator cuff tears. Materials and Methods: This was a comparative observational study conducted in a tertiary care orthopedic center. Patients diagnosed with rotator cuff tears and undergoing either arthroscopic or open repair were included. Functional outcomes were assessed using standardized shoulder scoring systems, along with pain evaluation and range of motion assessment. Radiological evaluation was performed to assess tendon integrity where applicable. Data were statistically analyzed to compare outcomes between the two groups. Results: Patients undergoing arthroscopic repair demonstrated superior early postoperative pain relief, faster functional recovery, and improved range of motion compared to those treated with open repair. At final follow-up, both groups showed significant improvement in functional scores, though arthroscopic repair showed a trend toward better overall outcomes with fewer postoperative complications. Conclusion: Arthroscopic rotator cuff repair provides better early functional recovery and reduced postoperative morbidity compared to open repair, while achieving comparable long-term outcomes. Arthroscopic repair should be preferred when technically feasible.