This systematic review hypothesizes that arthroscopic rotator cuff repair offers comparable functional outcomes to mini-open repair, with potential advantages in early postoperative recovery and pain reduction. A systematic review was conducted in accordance with PRISMA guidelines to compare clinical outcomes of arthroscopic versus mini-open rotator cuff repair. A comprehensive search of the literature was performed across PubMed, Scopus, and Web of Science databases to identify relevant studies published within the last five years. Inclusion criteria comprised studies that compared mini-open and arthroscopic rotator cuff repair techniques with outcome data on the Visual Analog Scale (VAS), Constant-Murley Score (CMS), Disabilities of the Arm, Shoulder and Hand (DASH) score, American Shoulder and Elbow Surgeons (ASES) score, or University of California, Los Angeles (UCLA) score. A total of eight studies involving 653 patients (331 arthroscopic, 322 mini-open) were included. Both techniques significantly improved functional outcomes and pain scores compared to preoperative values. VAS scores tended to be lower in the early postoperative period in arthroscopic cases. ASES, CMS, DASH, and UCLA scores showed no statistically significant differences between techniques, though some individual studies suggested slightly better outcomes in either group. The overall complication rates were similar, with arthroscopic repair associated with fewer deltoid-related issues and mini-open repair offering better visualization for complex cases. Arthroscopic and mini-open rotator cuff repairs yield comparable long-term outcomes in terms of pain relief, functional recovery, and complication rates. Arthroscopy may offer advantages in early recovery due to reduced soft tissue trauma, while mini-open repair remains a viable option for large or complex tears. Patient-specific factors and surgeon expertise should guide the choice of technique. High-quality, long-term randomized controlled trials are needed to confirm these findings and optimize treatment selection.