Background <p>Rotator cuff tears are common after traumatic anterior shoulder dislocation in patients aged ≥ 40 years, yet evidence on outcomes following open Latarjet with concomitant rotator cuff repair (RCR) remains limited. We compared long-term outcomes after open Latarjet with versus without concomitant RCR.</p> Methods <p>Retrospective comparative cohort study of patients aged ≥ 40 years undergoing primary open Latarjet. Patients were grouped as Latarjet with concomitant repair of a repairable (Goutallier ≤ 2; irreparable tears excluded) full-thickness rotator cuff tear (RCR) versus Latarjet without cuff repair (No-RCR). Outcomes included recurrence, complications and reoperations, pain (VAS), validated functional scores (Rowe, Walch-Duplay, Constant, SSV), return to sport, and radiographic graft position and arthropathy.</p> Results <p>Seventy-one patients were included at a mean follow-up of 10.7 ± 5.3 years (No-RCR <i>n</i> = 49; RCR <i>n</i> = 22). Recurrent dislocation occurred in 2/49 (4%) No-RCR and 2/22 (9%) RCR patients, both RCR recurrences progressed to reverse shoulder arthroplasty. Overall complication rates (31% vs. 27%, <i>p</i> = 0.51) and reoperation rates (8% vs. 14%, <i>p</i> = 0.17) were not significantly different. Persistent pain and/or stiffness was more frequent following RCR (59% vs. 17%, <i>p</i> = 0.001) and return to sport was lower (50% vs. 82%, <i>p</i> = 0.037), while functional scores and radiographic arthropathy were otherwise comparable.</p> Conclusion <p>In patients aged ≥ 40 years, open Latarjet with concomitant repair of a repairable full-thickness cuff tear provides durable stabilization and similar long-term scores to Latarjet alone, but residual pain/stiffness and reduced return to sport are more common after concomitant cuff repair.</p> Level of evidence <p>Level III; retrospective comparative study.</p>