Background: Arthroscopic rotator cuff repair (RCR) is a common procedure, yet long-term patient-centered outcome studies remain limited. This study aims to evaluate the outcomes of arthroscopic RCR using a single-row metallic anchor technique over a 12-year follow-up, focusing on patient-reported outcomes and potential risk factors. Methods: A monocentric cohort study was conducted on patients who underwent complete arthroscopic RCR with a single-row metallic anchor technique from January 2007 to July 2011. A total of 628 patients completed three standardized questionnaires: Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH), American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES), and the Simple Shoulder Test (SST). They were also asked for their overall satisfaction on the procedure with a single direct question. Outcomes were analyzed by gender, age at surgery, lesion pattern, and follow-up duration. Results: The mean follow-up period was 12.9 ± 1.3 years. Overall satisfaction was 96.5%. The mean scores for QuickDASH, ASES, and SST were 7.2 ± 15.7, 83.8 ± 23.9, and 89.9 ± 22.3, respectively. Female patients reported significantly lower QuickDASH (p < 0.001), ASES (p < 0.001), and SST (p = 0.004) than male patients, but overall satisfaction did not differ by gender. Age, number of tendons repaired, anterior tear, and follow-up length were not significantly associated with differences in outcome measures. Conclusions: Single-row arthroscopic RCR provides excellent long-term patient-reported outcomes and high patient satisfaction. Female gender may be associated with slightly lower functional scores, yet satisfaction remains unaffected. This study supports the single-row technique as a reliable, efficient, and cost-effective option for long-term success in RCR, challenging the need for more complex multi-anchor approaches.