Arthroscopic rotator cuff repair has evolved significantly in the last decade and has become a standard treatment. Satisfactory results of arthroscopic subacromial decompression (ASD) in the treatment of rotator cuff tears have also been reported (1). The aim of this study was to compare the outcome following arthroscopic repair versus decompression alone in patients with small & medium rotator cuff tears (Classification of Post, Silver & Singh (2). There were 114 patients in the ASD group and 96 in the Arthroscopic rotator cuff repair group (RCR). The groups were statistically comparable in terms of patient age & gender. Clinical follow-up was performed at a minimum of 12 months post -operatively (average 36 months). The average Post-op Constant score was 69.8 for the ASD group and 86.4 for the RCR group. The average post-op pain score (S.D) in the ASD group was 10.9 (± 4.3) and in the RCR group was 13.6 (± 3.1). Post operative strength was 7.6 (± 3.6) in the ASD group and 16.7 (± 5.4) in the RCR group.26 patients (22.8%) in the ASD group and 3 (3.3%) of the RCR group required futher surgery. Patient satisfaction (maximum 10 points) was 7.4% in the ASD group and 8.9 (± 1.4) in the RCR. The results of this study support arthroscopic rotator cuff repair. Shoulder strength is improved and there is significant reduction in the need for revision surgery.