BACKGROUND: Rotator cuff repairs in patients aged older than 65 years are reported to have a high failure rate. Furthermore, asymptomatic cuff tearing is frequent in this age group, so the value of tendon repair has been questioned. Our aim was to review the results of cuff repair in these patients and to identify factors predicting outcome. METHODS: In this study, 58 patients aged older than 65 years with reparable supraspinatus tears underwent primary open (22 patients) or arthroscopic (36 patients) repair. The leading symptom was pain despite nonoperative treatment for at least 6 months. Tendon healing was assessed on ultrasonography. RESULTS: Forty-four shoulders could be reviewed at a mean follow-up of 57 months (range, 24-112 months). Tendon healing was complete in 31 shoulders (70%). The mean Constant score (CS) improved from 49 points (range, 5-74 points) preoperatively to 78 points (range, 23-100 points) at follow-up (P < .05). The respective values for the relative CS were 64% (range, 7%-97%) and 95% (range, 33%-100%) (P < .05). The mean CS was better for healed repairs (82 points [range, 57-100 points]) than for nonhealed repairs (61 points [range, 23-88 points]) (P < .05). In 41 of 44 cases (93%), patients were satisfied or very satisfied with the operation. Though not statistically significant, dominance, cortisone injection, smoking, and tendon retraction appeared to favor nonhealing. CONCLUSIONS: Isolated supraspinatus tendon repairs in patients aged older than 65 years have a high healing potential and yield good clinical results with even better outcome if the repairs heal. Repair of symptomatic single-tendon rotator cuff tears in patients aged older than 65 years who do not respond to conservative treatment appears justified.