One hundred twenty patients with chronic unilateral rotator cuff tears were randomized to arthroscopic rotator cuff repair (ARCR) with bone marrow stimulation (BMS; n=60) or with decortication (DEC; n=60) as footprint preparation. The primary outcome was 24-month American Shoulder and Elbow Surgeons (ASES) score. Secondary outcomes included VAS pain, Constant score, active ROM, abduction strength, and rotator cuff integrity by Sugaya grade on 24-month MRI. Outcomes were assessed up to 24 months. Overall, the results revealed no between-group difference in ASES at 24 months, but BMS yielded higher abduction strength and lower incomplete-healing rates. In short, while patient-reported shoulder function was similar, BMS improved structural healing and strength—benefits most evident in patients with higher preinjury shoulder activity.