This study aimed to ascertain whether: (1) the newer technology for rotator cuff repair (RCR) has improved operative time; (2) operative time independently affects the outcomes of RCR; and (3) there are any cost savings associated with performing the procedure in a more expeditious manner. We investigated operative time, retear rate, patient-derived and examiner-derived outcomes, and reviewed costs, for 4 groups of shoulder patients who received open RCR or 1 of 3 arthroscopic RCR techniques using Mitek (knotted) anchors or Opus Magnum (knotless) anchors repaired either from the bursal side or the undersurface. The operative time lengths were: open RCR, 58 minutes; Mitek RCR, 53 minutes; Opus bursal side RCR, 38 minutes; and Opus undersurface RCR, 22 minutes (P < 0.001). Retear rates were 51%, 27%, 27%, and 20%, respectively (P < 0.001). Strength measurements and pain during rest were significantly related to operative time whereas other pain measures were not. The shorter operative time for undersurface RCR substantially reduced the cost per patient. Hence, the undersurface technique with Opus anchors offers certain advantages.