Single-Row Versus Double-Row Arthroscopic Rotator Cuff Repair: A Prospective Randomized Clinical Study

doi:10.1016/j.arthro.2008.09.018

Arthroscopy: The Journal of Arthroscopic & Related Surgery

Volume 25, Issue 1, January 2009, Pages 4-12

https://doi.org/10.1016/j.arthro.2008.09.018 Get rights and content

Purpose

The purpose of this study was to compare the clinical outcome of arthroscopic rotator cuff repair with single-row and double-row techniques.

Methods

Eighty patients with a full-thickness rotator cuff tear underwent arthroscopic repair with suture anchors. They were divided into 2 groups of 40 patients according to repair technique: single row (group 1) or double row (group 2). Results were evaluated by use of the Disabilities of the Arm, Shoulder and Hand (DASH) and Work-DASH self-administered questionnaires, normalized Constant score, and muscle strength measurement. On analyzing the results at a 2-year follow-up, we considered the following independent variables: baseline scores; age; gender; dominance; location, shape, and area of cuff tear; tendon retraction; fatty degeneration; treatment of biceps tendon; and rotator cuff repair technique (anchors or anchors and side to side). Univariate and multivariate statistical analyses were performed to determine which variables were independently associated with the outcome. Significance was set at P < .05.

Results

Of the patients, 8 (10%) were lost to follow-up. Comparison between groups did not show significant differences for each variable considered. Overall, according to the results, the mean DASH scores were 15.4 ± 15.6 points in group 1 and 12.7 ± 10.1 points in group 2; the mean Work-DASH scores were 16.0 ± 22.0 points and 9.6 ± 13.3 points, respectively; and the mean Constant scores were 100.5 ± 17.8 points and 104.9 ± 21.8 points, respectively. Muscle strength was 12.7 ± 5.7 lb in group 1 and 12.9 ± 7.0 lb in group 2. Univariate and multivariate analysis showed that only age, gender, and baseline strength significantly and independently influenced the outcome. Differences between groups 1 and 2 were not significant.

Conclusions

At short-term follow-up, arthroscopic rotator cuff repair with the double-row technique showed no significant difference in clinical outcome compared with single-row repair.

Level of Evidence

Level I, high-quality randomized controlled trial with no statistically significant differences but narrow confidence intervals.

Section snippets

Methods

For this study, we enlisted 80 patients with a full-thickness rotator cuff tear who accepted our invitation to enter the study and who signed an agreement disclosure form. In all cases the lesion was diagnosed preoperatively with a magnetic resonance imaging (MRI) study of the affected shoulder. Inclusion criteria for the study group were patients with a repairable full-thickness tear of the supraspinatus or the posterior-superior rotator cuff. Patients with rotator interval involvement or

Results

The mean follow-up was 24.8 ± 1.4 months. We lost 8 patients to follow-up, 3 from group 1 and 5 from group 2. We did not determine the causes for their lack of follow-up participation. The final evaluation was thus carried out in 72 patients. There were 34 men and 38 women. The age ranged between 41 and 74 years (mean age, 56.8 ± 8.7 years). Comparison between groups did not show significant differences between them for each independent variable (Table 1).

Comparison between groups did not show

Discussion

One of the most common complications of arthroscopic rotator cuff repair is rerupture.3, 4 Partial or complete failure of repair does not seem to be correlated with functional outcome³¹; however, tendon healing is significantly correlated with postoperative strength.⁴ Among the factors that have been investigated as predictors of durability of rotator cuff repair, primary fixation of tendon to bone is considered a success key of the procedure. For this reason, many different suture

Conclusions

At short-term follow-up, arthroscopic repair of full-thickness rotator cuff tears with the double-row technique showed no significant difference in clinical outcome compared with single-row repair.

References (31)

J.J. Warner et al.
Arthroscopic versus mini-open rotator cuff repair: A cohort comparison study
Arthroscopy
(2005)
J. Ide et al.
A comparison of arthroscopic and open rotator cuff repair
Arthroscopy
(2005)
M. Apreleva et al.
Rotator cuff tears: The effect of the reconstruction method on three-dimensional repair site area
Arthroscopy
(2002)
S. Fealy et al.
Mini-open rotator cuff repair using a two-row fixation technique: Outcomes analysis in patients with small, moderate, and large rotator cuff tears
Arthroscopy
(2002)
S.W. Meier et al.
The effect of double-row fixation on initial repair strength in rotator cuff repair: A biomechanical study
Arthroscopy
(2006)
M.C. Park et al.
Part I: Footprint contact characteristics for a transosseous-equivalent rotator cuff repair technique compared with a double-row repair technique
J Shoulder Elbow Surg
(2007)
M.C. Park et al.
Part II: Biomechanical assessment for a footprint-restoring transosseous-equivalent rotator cuff repair technique compared with a double-row repair technique
J Shoulder Elbow Surg
(2007)
H. Sugaya et al.
Functional and structural outcome after arthroscopic full-thickness rotator cuff repair: Single-row versus dual-row fixation
Arthroscopy
(2005)
D.J. Reardon et al.
Clinical evidence shows no difference between single- and double-row repair for rotator cuff tears
Arthroscopy
(2007)
B. Fuchs et al.
Fatty degeneration of the muscles of the rotator cuff: Assessment by computed tomography versus magnetic resonance imaging
J Shoulder Elbow Surg
(1999)

A.D. Mazzocca et al.

The biomechanical evaluation of four fixation techniques for proximal biceps tenodesis

Arthroscopy

(2005)

R. Padua et al.

Italian version of the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaireCross-cultural adaptation and validation

J Hand Surg [Br]

(2003)

J. Karlsson et al.

Considerations on sample size and power calculations in randomized clinical trials

Arthroscopy

(2003)

C.R. Constant et al.

A review of the Constant score: Modifications and guidelines for its use

J Shoulder Elbow Surg

(2008)

L.M. Galatz et al.

The outcome and repair integrity of completely arthroscopically repaired large and massive rotator cuff tears

J Bone Joint Surg Am

(2004)

Cited by (197)

A scoping review and best evidence synthesis for treatment of partial-thickness rotator cuff tears
2024, Journal of Shoulder and Elbow Surgery
Rotator cuff disorders include a broad spectrum of pathological conditions including partial-thickness and full-thickness tears. Studies have shown partial-thickness rotator cuff tear (PTRCT) prevalence to be twice that of full-thickness tears. In the working population, PTRCTs are one of the most common causes of shoulder pain and often result in occupational disability due to pain, stiffness, and loss of shoulder function. Treatment of PTRCTs remains controversial. The purpose of this study was to consolidate the existing high-quality evidence on best management approaches in treating PTRCTs using both nonoperative and operative approaches.
A scoping review with best evidence synthesis was performed as per the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews. MEDLINE (OVID), EMBASE (OVID), Cochrane Library (Wiley), SCOPUS, Web of Science Core Collection, CINAHL Plus with Full Text (EBSCOhost), PubMed Central, and Science Direct were searched from 2000 to March 3, 2023. Level 1 studies, and systematic reviews and meta-analyses that included level 1 and 2 studies, were included.
The search yielded 8276 articles. A total of 3930 articles were screened after removing 4346 duplicates. Application of inclusion criteria resulted in 662 articles that were selected for full-text review. Twenty-eight level 1 studies, 1 systematic review, 4 meta-analyses, and 1 network meta-analyses were included in the best evidence synthesis. Nonoperative strategies included injections (ie, platelet-rich plasma, corticosteroid, prolotherapy, sodium hyaluronate, anesthetic, and atelocollagen), exercise therapy, and physical agents. Operative interventions consisted of débridement, shaving of the tendon and footprint, transtendon repair, and traditional suture anchor repair techniques with and without tear completion. Both nonoperative and operative strategies demonstrated effectiveness at managing pain and functional outcome for PTRCTs. The evidence supports the effectiveness of surgical intervention in treating PTRCTs regardless of arthroscopic technique.
The results of this scoping review do not support superiority of operative over nonoperative management and suggest that both strategies can be effective at managing pain and functional outcome for PTRCTs. Surgery, however, is the most invasive and costly approach, with the highest risk of complications such as infection. Other variables such as patient expectation, treating practitioner bias, or preference may change which modalities are offered and in what sequence.
Primary Arthroscopic Repair for Massive Rotator Cuff Tears Results in Good Shoulder Function, Low Pain, and Satisfactory Outcomes at 2-Year Minimum Follow-Up
2024, Arthroscopy - Journal of Arthroscopic and Related Surgery
To evaluate outcomes of patients who underwent primary arthroscopic repair for massive rotator cuff tears (MRCTs).
Patients with MRCTs (full-thickness tear of 2 or more tendons or full-thickness tear ≥5 cm) who underwent arthroscopic repair with a minimum follow-up of 2 years were retrospectively reviewed (n = 51). All patients had preoperative magnetic resonance imaging used to characterize pattern of tear, degree of fatty degeneration (Goutallier classification), and degree of rotator cuff arthropathy (Hamada classification). Outcomes were determined by American Shoulder and Elbow Surgeons (ASES) scores and Penn Shoulder Scores (PSS).
A total of 51 patients with a minimum 2.3-year follow-up (mean, 5.4 years; range, 2.3-9.7 years) were included in this study. Mean ASES score was 46.1 ± 7.8 (95% CI, 43.9-48.3) for pain and 39.4 ± 12.1 (95% CI, 36.0-42.8) for function. Total ASES score averaged 85.5 ± 18.4 (95% CI, 80.4-90.7). PSS had a mean pain score of 26.8 ± 4.4 (95% CI, 25.4-28.1), a mean satisfaction score of 7.9 ± 2.9 (95% CI, 7.0-8.2), and a mean function score of 48.5 ± 13.5 (95% CI, 44.7-52.3). Total PSS averaged 83.2 ± 19.6 (95% CI, 77.7-87.7). No correlation was found between Goutallier grade and ASES/PSS scores or between Hamada grade and ASES/PSS scores. Three patients underwent reoperation after primary arthroscopic repair of an MRCT (5.9%).
Patients with MRCTs who undergo primary arthroscopic repair have postoperative outcome scores indicative of good shoulder function, low pain, and high satisfaction. The rate of reoperation for individuals who underwent primary arthroscopic repair with MRCTs was low at 6%.
Level IV, retrospective case series.
Arthroscopic Modified Double-Pulley Suture-Bridge Repair of Medium-Sized Supraspinatus Tendon Tears
2024, Arthroscopy Techniques
At present, the repair patterns for medium-sized supraspinatus tendon tears are double- and single-row repairs. However, the limitations of double-row repair include excessive anchor implantation and incremental surgical cost and time, whereas a deficient tendon-bone contact area exists with single-row repair. The modified double-pulley suture-bridge repair presented in this study is an arthroscopic technique using 3 double-loaded suture anchors combined with a double-pulley technique to form a hybrid repair pattern with a double row as the mainstay and a single row as the supplement. In the treatment of medium-sized tendon tears, the modified double-pulley suture-bridge repair can not only maximize the tendon-bone contact area but also lower the surgical cost and shorten the operative time. The surgical technique is described, including pearls and pitfalls, as well as advantages and disadvantages.
Arthroscopic rotator cuff repair using a single or double row technique: A meta-analysis of randomized clinical trial
2024, Revista Espanola de Cirugia Ortopedica y Traumatologia
Comparar la técnica doble hilera versus la técnica de hilera simple para la reparación artroscópica del manguito rotador, con el fin de valorar si hay diferencias clínicas, funcionales y radiológicas.
Revisión sistemática de ensayos clínicos aleatorizados que comparen los resultados clínicos de la técnica doble hilera versus la técnica de hilera simple en la reparación artroscópica del manguito rotador. Se analizaron las variables demográficas, clínicas y quirúrgicas, incluyendo escalas funcionales, tasa de curación del tendón y tasa de re-rupturas.
Trece ensayos clínicos aleatorizados fueron seleccionados. Se analizaron 437 pacientes en el grupo de hilera simple (50,7%) y 424 pacientes en el grupo de doble hilera (49,3%). No se encontraron diferencias significativas entre ambos grupos en lo referente a la edad (p = 0,84), sexo (p = 0,23) y pérdidas durante el seguimiento (p = 0,52). La técnica de doble hilera obtuvo mejores resultados en la escala UCLA, siendo esta diferencia estadísticamente significativa (p = 0,01). No se encontraron diferencias significativas en la escala Constant-Murley (p = 0,87) ni en la escala ASES (p = 0,56). Del mismo modo, hubo una mayor tasa de curación (p = 0,006) y menor tasa de re-rupturas del manguito rotador con la técnica de doble hilera (p = 0,006).
En la reparación del manguito rotador se halló que la técnica doble hilera es superior a la técnica hilera simple en términos de una mejor puntuación en la escala UCLA, una mejor tasa de curación del tendón y una menor tasa de re-rupturas. No se encontraron diferencias significativas a nivel clínico en la escala Constant-Murley ni en la escala de ASES.
To compare the double row technique versus the single row technique for arthroscopic rotator cuff repair, in order to assess whether there are clinical differences.
Systematic review of randomized clinical trials comparing the clinical results of the double-row technique versus the single-row technique in arthroscopic rotator cuff repair. Demographic, clinical, and surgical variables were analyzed, including functional scores, tendon healing rate, and re-tear rate.
Thirteen randomized clinical trials were selected. 437 patients in the single row group (50.7%) and 424 patients in the double row group (49.3%) were analyzed. No significant differences were found between the two groups in terms of age (P = .84), sex (P = .23) and loss to follow-up (P = .52). Significant differences were found for the better results of the double row technique at the UCLA level (P = .01). No significant differences were found on the Constant-Murley scale (P = .87) or on the ASES scale (P = .56). Similarly, there was a higher healing rate (P = .006) and less risk of rotator cuff re-tears with the double row technique (P = .006).
In rotator cuff repair, the double row technique was found to be superior to the single row technique in terms of better UCLA score, better tendon healing rate, and lower re-tear rate. No clinically significant differences were found on the Constant-Murley scale or on the ASES scale.
Rotator Cuff Repair: How Many Rows?
2023, Operative Techniques in Sports Medicine
Technical considerations of the rotator cuff repair remain of great importance as retear rates remain high. The double-row (DR) rotator cuff repair was designed to better restore the native enthesis footprint to maximize healing. The DR repair features a medial and lateral row of suture anchors. Anatomical and cadaveric studies have demonstrated improved footprint restoration with DR repair. Biomechanically, the DR repair has a superior load to failure, decreased gap formation under cyclic loading, and greater contact areas and pressures. It is unclear whether the number of sutures per anchor may be more important than the number of rows and the row configuration. Medial row knots and suture tape constructs may improve the biomechanics of the repair, but the impact on clinical outcomes is unknown. High-quality clinical studies have shown that the DR repair in small to medium tears does not yield better clinical outcomes than the single-row (SR) and is not cost-effective. Healing rates seem to improve with the DR repair, and retear rates may be slightly reduced. However, in larger tears, the DR repair demonstrates favorable clinical outcomes with significant increases in functional scores, healing rates, and retear rates compared to SR repair. Although the DR repair has biomechanical advantages to SR constructs, clinical evidence suggests that the double-row repair should be reserved for large to massive tear patterns.
Arthroscopic Rotator Cuff Repair: A Review of Surgical Techniques and Outcomes
2023, Clinics in Sports Medicine

View all citing articles on Scopus

: The authors report no conflict of interest. Drs. Grasso and Milano contributed equally to the paper.

View full text

Original ArticleSingle-Row Versus Double-Row Arthroscopic Rotator Cuff Repair: A Prospective Randomized Clinical Study

Purpose

Methods

Results

Conclusions

Level of Evidence

Section snippets

Methods

Results

Discussion

Conclusions

Arthroscopy

Arthroscopy

Arthroscopy

Arthroscopy

Arthroscopy

J Shoulder Elbow Surg

J Shoulder Elbow Surg

Arthroscopy

Arthroscopy

J Shoulder Elbow Surg

Arthroscopy

J Hand Surg [Br]

Arthroscopy

J Shoulder Elbow Surg

The outcome and repair integrity of completely arthroscopically repaired large and massive rotator cuff tears

J Bone Joint Surg Am

Original Article
Single-Row Versus Double-Row Arthroscopic Rotator Cuff Repair: A Prospective Randomized Clinical Study