Meta-analysis
Single-Row Repair Versus Double-Row Repair of Full-Thickness Rotator Cuff Tears

https://doi.org/10.1016/j.arthro.2011.01.014Get rights and content

Purpose

The purpose of this meta-analysis was to assess whether there are differences in the outcomes between single-row and double-row rotator cuff repair.

Methods

Using MEDLINE, SCOPUS, SCIRUS, CINAHL, and the Cochrane Library, as well as a hand search, we searched for articles comparing single-row and double-row rotator cuff repair that were published before September 2009. The controlled clinical studies that met the inclusion and exclusion criteria were assessed for quality of methodology. Two of the authors performed this review and assessment. Any disagreements were resolved by the third author.

Results

Three randomized controlled studies and two controlled clinical cohort studies were included in this meta-analysis. These studies were assessed as having a moderate to high level of evidence. The results showed that double-row repair improved tendon healing and provided greater external rotation but with significantly increased operative time. Furthermore, this study found that double-row repair decreased the recurrence rate. However, there were no statistically significant differences found in shoulder function as assessed by Constant score; American Shoulder and Elbow Surgeons (ASES) score; University of California, Los Angeles (UCLA) score; Western Ontario Rotator Cuff (WORC) index; Disabilities of the Arm, Shoulder and Hand (DASH) score; muscle strength; forward flexion; internal rotation; patient satisfaction; return to work; and adverse events.

Conclusions

Despite the fact that double-row repair shows a significantly higher rate of tendon healing and greater external rotation than does single-row repair, there is no significant improvement in shoulder function, muscle strength, forward flexion, internal rotation, patient satisfaction, or return to work.

Level of Evidence

Level II, meta-analysis of Level I and Level II studies.

Section snippets

Methods

Using MEDLINE, SCOPUS, SCIRUS, CINAHL, and the Cochrane library, as well as a hand search, we searched for articles that were published before September 2009. The search terms “single-row” and “double-row” were used. Inclusion criteria included controlled clinical trials, quasi-randomized controlled trials, and randomized controlled trials that compared the results of single-row rotator cuff repair with the results of double-row rotator cuff repair. All double-row repair techniques, described

Results

Six clinical trials comparing the outcomes of single-row and double-row repair were identified. One study, conducted by Brady et al.,19 was excluded because of its retrospective design. Thus 5 studies met our criteria and were included and assessed for methodologic quality. Two studies (Charousset et al.20 and Park et al.21) had a cohort design, and three (Burks et al.,22 Franceschi et al.,23 and Grasso et al.24) were randomized controlled trials. The details of these studies are shown in Table

Discussion

The goal of rotator cuff repair is to achieve high initial fixation strength, minimize gap formation, maintain mechanical stability under cyclic loading, and optimize the biological healing of the tendon-bone interface. Many surgical techniques have been developed to achieve these goals. Transosseous repairs are shown to have the highest ultimate load resistance and the lowest gap formation.13 Double-row repairs, especially using a “transosseous-equivalent technique,” are designed to achieve

Conclusions

Despite the fact that double-row repair shows a significantly higher rate of tendon healing and greater external rotation than does single-row repair, there is no significant improvement in shoulder function, muscle strength, forward flexion, internal rotation, patient satisfaction, or return to work.

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    The authors report no conflict of interest.

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