Rotator cuff tears are a common cause of shoulder dysfunction, particularly in older adults. Using data from 700 shoulder RCTs and more than 111,000 patients, a clearer view of how single- and double-row repairs compare in rotator cuff tears appears. Across the trials, single-row repair consistently led to shorter operative times, while double-row repair provided small gains in function and better healing, with lower retear rates—though these advantages didn’t translate into meaningful differences in pain. Subgroup comparisons with suture-bridge techniques showed no clear functional or healing benefit. Both approaches appeared safe, with no serious adverse events reported. Ongoing global trials will help refine these findings, but current evidence suggests both techniques remain viable options depending on goals, tear characteristics, and surgeon preference.