The arthroscopic management of small- to moderate-sized rotator cuff tears has been shown to result in outcomes equal to those of mini-open repairs. Although the clinical outcome of arthroscopic repair of large to massive tears has been generally favorable, objective evaluation of cuff has shown the healing rate to be considerably lower. This may in part be due to the poor biologic healing potential present for many larger tears. Significant improvements have been made in the arthroscopic treatment of rotator cuff tears and have included a more thorough appreciation for rotator cuff tear patterns, more anatomically and biomechanically sound reduction strategies, better instruments for suture management, and stronger suture and anchor implant materials. Complications aside from repair failure have been low. Rehabilitation programs must take into account the tissue quality and security of the repair construct. Over the next decade, biologic enhancements to healing will play a major role in increasing the success rate of rotator cuff healing.