Objectives This cross-sectional study aimed to explore the knowledge, attitude and practice (KAP) of patients with rotator cuff tears towards arthroscopic shoulder surgery (ASS), based on the hypothesis that the knowledge of the procedure among patients would be sufficient, which in turn might influence their practice and attitude. Design Cross-sectional study. Setting Patients were recruited from Tong Ren Hospital between September and October 2022. Participants A total of 588 patients were included in the study. Interventions No interventions were administered. Primary and secondary outcome measures Knowledge, attitude and practice scores were measured using a self-administered questionnaire. Results Out of 588 patients included, 50.51% had undergone ASS. Lower education level and monthly income, shorter weekly exercise time and shorter disease duration were identified as independent risk factors for the KAP total score. Structural equation modelling revealed a direct positive effect of knowledge on attitude, but neither knowledge nor attitude influenced practice scores. Conclusions Patients with rotator cuff tears demonstrated relatively poor knowledge, a neutral attitude and moderate practice towards ASS, highlighting the need for patient education and counselling to enhance understanding and decision-making regarding ASS.