Background: Double-row arthroscopic rotator cuff repair has become more popular, and some studies have shown better footprint coverage and improved biomechanics of the repair. Hypothesis: Double-row rotator cuff repair leads to superior cuff integrity and early clinical results compared with single-row repair. Study Design: Randomized controlled trial; Level of evidence, 1.Methods: Forty patients were randomized to either single-row or double-row rotator cuff repair at the time of surgical intervention. Patients were followed with clinical measures (UCLA, Constant, WORC, SANE, ASES, as well as range of motion, internal rotation strength, and external rotation strength). Magnetic resonance imaging (MRI) studies were performed on each shoulder preoperatively, 6 weeks, 3 months, and 1 year after repair. Results: Mean anteroposterior tear size by MRI was 1.8 cm. A mean of 2.25 anchors for single row (SR) and 3.2 for double row (DR) were used. There were 2 retears at 1 year in each group. There were 2 additional cases that had severe thinning in the DR repair group at 1 year. The MRI measurements of footprint coverage, tendon thickness, and tendon signal showed no significant differences between the 2 repair groups. At 1 year, there were no differences in any of the postoperative measures of motion or strength. At 1 year, mean WORC (SR, 84.8; DR, 87.9), Constant (SR, 77.8; DR, 74.4), ASES (SR, 85.9; DR, 85.5), UCLA (SR, 28.6; DR, 29.5), and SANE (SR, 90.9; DR, 89.9) scores showed no significant differences between groups. Conclusions: No clinical or MRI differences were seen between patients repaired with a SR or DR technique.