Rotator cuff repair has gained increasing popularity in recent years. Fixation of the tendon to the bone presents challenging difficulties like those in many parts of the human body. There is ongoing research concerning clinical and biomechanical features of open and arthroscopic repair methods, though accumulated evidence in the past years suggests that the latter may provide a more secure fixation. Considering the general advantages of arthroscopy, we may propose that arthroscopic rotator cuff repair with anchor fixation will gain more acceptance. This article reviews the most recent literature on the subject.