Background: Rotator cuff tears are among the most common shoulder pathologies causing pain and functional limitations. Surgical repair can be performed either via arthroscopic or open approaches, but the optimal technique remains a subject of debate. Comparative analyses of patient outcomes are crucial to guide evidence-based clinical decision-making. Methods: A prospective, comparative study was conducted at a single tertiary care center. A total of 100 patients with confirmed full-thickness rotator cuff tears were randomized to receive either arthroscopic repair (n=50) or open repair (n=50). Baseline characteristics, operative time, and length of hospital stay were recorded. Outcomes included functional scores—American Shoulder and Elbow Surgeons (ASES) score and Constant-Murley score—pain assessed by the Visual Analog Scale (VAS), re-tear rates on follow-up imaging, and complication rates over a 12-month follow-up period. Results: Both groups achieved significant improvements in functional scores at 12 months (p<0.05). However, patients undergoing arthroscopic repair reported significantly lower VAS pain scores at 6 weeks (p<0.01) and had a shorter hospital stay by an average of 1.5 days compared to the open repair cohort. Re-tear rates were 8% in the arthroscopic group and 10% in the open group, a difference that was not statistically significant (p=0.62). The overall complication rate did not differ significantly between groups. Conclusion: Arthroscopic rotator cuff repair demonstrates comparable clinical and functional outcomes to open repair but offers benefits in terms of reduced postoperative pain and shorter hospital stay. Given the lack of significant difference in re-tear and complication rates, arthroscopic repair appears to be a favorable option for the majority of patients. Larger multicenter studies with longer follow-up are warranted to confirm these findings.