Symptomatic rotator cuff tears can now be treated with arthroscopic trans-osseous (TO) rotator cuff techniques. From a biological as well as biomechanical perspective, TO sutures are considered superior. This study analyzed midterm functional outcomes of arthroscopic TO rotator cuff repair using special needles called giant needles. Methods: 36 patients (14 females and 22 males with a mean age of 59.3 years) underwent arthroscopic TO rotator cuff repair for symptomatic full-thickness tears. Pre- and post-operative range of motion (ROM) and constant shoulder (CS) score of the affected shoulders were recorded. Patients were followed up at 6, 12, and 24 months after surgery. Results: The mean pre-operative CS score improved from 43.54 to 87.52. The mean flexion range improved from 96° to 158° while the mean external rotation range improved from 33° to 68°. We recorded two cases of intra-operative tunnel failure, two cases with post-operative stiffness and one case of infection. One case underwent arthroscopic revision of rotator repair for a traumatic cuff re-tear. Conclusion: The arthroscopic TO giant needle rotator cuff repair is an effective technique with satisfactory midterm outcome scores. Further radiological evaluation for healing rates is needed