Purpose: Our purpose was to perform a systematic review and meta-analysis of the clinical outcomes of single-row versus double-row repair. Methods: An electronic search was performed using PubMed, EMBASE, and the Cochrane Library up to September 30, 2012. Studies that met the inclusion and exclusion criteria were assessed for quality of methodology. The primary analysis included Level I evidence from studies examining single-row versus double-row repair. The second meta-analysis and subgroup analysis were performed for evidence Levels I, II, and III. Results: The primary analysis of studies providing 6 Level I randomized controlled trials showed no clinically significant differences in Constant scores, University of California, Los Angeles (UCLA), and American Shoulder and Elbow Surgeons (ASES) scores between double-row and single-row rotator cuff repair. The overall odds ratio (OR) of intact rotator cuff tendon healing was 1.93 in patients treated with double-row versus single-row repair, and the difference was significant. The results of the second meta-analysis including evidence Levels I, II, and III were similar to those of the primary analysis. In the subgroup with tears less than 3 cm, there was no statistically significant difference between the groups with regard to shoulder functional score and structure integrity. A statistically significant benefit of double-row repair in the ASES and UCLA scores was observed in the subgroup with tears greater than 3 cm; however, these differences were not clinically significant. The OR for tendon healing was found to be more favorable for double-row repair than for single-row repair in the subgroup with tears greater than 3 cm. Conclusions: Double-row repair provides a significantly higher rate of intact tendon healing than does single-row repair, and this advantage was mainly reflected in patients with large or massive tears. However, this benefit did not translate into clinically confirmed functional improvement. Thus, the double-row technique should be used only in carefully selected patients. Level of Evidence: Level III, systematic review of Levels I, II, and III studies.