Arthroscopic Single-Row Versus Double-Row Repair for Full-Thickness Posterosuperior Rotator Cuff Tears: A Critical Analysis Review

Over the past two decades, arthroscopic rotator cuff repair has become one of the most popular orthopaedic surgical procedures because of its proven ability to diminish pain and improve function in patients with symptomatic rotator cuff tears. As a result of this increasing demand, arthroscopic techniques have evolved rapidly in an effort to improve structural integrity, biomechanical function, and, ultimately, clinical outcomes. With the increasing number of techniques available for the repair of full-thickness rotator cuff tears, debate has arisen regarding the clinical superiority of any one of these methods over the others. Specifically, this debate has centered on traditional single-row versus traditional double-row repair constructs (Fig. 1). Therefore, the purpose of this article is to present a critical review of the most relevant evidence and to provide clinical care recommendations regarding arthroscopic single-row versus double-row rotator cuff repair constructs. Fig. 1 Traditional single-row suture configuration utilizes two lateral anchors tied in a simple stitch pattern ( Fig. 1 , A ). Traditional double-row suture configuration utilizes an additional medial row of anchors with mattress stitches ( Fig. 1 , B ). The rotator cuff represents a confluence of four tendons that envelop the humeral …

[1]  F. Barber,et al.  A biomechanical comparison of tendon-bone interface motion and cyclic loading between single-row, triple-loaded cuff repairs and double-row, suture-tape cuff repairs using biocomposite anchors. , 2012, Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association.

[2]  A. Mazzocca,et al.  Optimizing pressurized contact area in rotator cuff repair: the diamondback repair. , 2012, Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association.

[3]  Andrew R Curran,et al.  The insertional footprint of the rotator cuff: an anatomic study. , 2006, Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association.

[4]  P. Millett,et al.  Arthroscopic rotator cuff repair: scientific rationale, surgical technique, and early clinical and functional results of a knotless self-reinforcing double-row rotator cuff repair system. , 2010, Journal of shoulder and elbow surgery.

[5]  A. Martínez,et al.  Single-row versus double-row arthroscopic repair in the treatment of rotator cuff tears: a prospective randomized clinical study , 2012, International Orthopaedics.

[6]  J. Schoolfield,et al.  A biomechanical comparison of 2 techniques of footprint reconstruction for rotator cuff repair: the SwiveLock-FiberChain construct versus standard double-row repair. , 2009, Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association.

[7]  I. Sekiya,et al.  Humeral insertion of the supraspinatus and infraspinatus. New anatomical findings regarding the footprint of the rotator cuff. , 2009, The Journal of bone and joint surgery. American volume.

[8]  J. Crim,et al.  A Prospective Randomized Clinical Trial Comparing Arthroscopic Single-and Double-Row Rotator Cuff Repair , 2009, The American journal of sports medicine.

[9]  I. Clarke,et al.  UCLA anatomic total shoulder arthroplasty. , 1981, Clinical orthopaedics and related research.

[10]  E. Sabri,et al.  A multicenter randomized controlled trial comparing single-row with double-row fixation in arthroscopic rotator cuff repair. , 2012, The Journal of bone and joint surgery. American volume.

[11]  Chien-Lin Liu,et al.  Clinical outcome and imaging of arthroscopic single-row and double-row rotator cuff repair: a prospective randomized trial. , 2012, Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association.

[12]  R. Kvitne,et al.  Biomechanical Comparison of a Single-Row versus Double-Row Suture Anchor Technique for Rotator Cuff Repair , 2006, The American journal of sports medicine.

[13]  C Gerber,et al.  Mechanical strength of repairs of the rotator cuff. , 1994, The Journal of bone and joint surgery. British volume.

[14]  C. Constant,et al.  A clinical method of functional assessment of the shoulder. , 1987, Clinical orthopaedics and related research.

[15]  K. Yamaguchi,et al.  Symptomatic progression of asymptomatic rotator cuff tears: a prospective study of clinical and sonographic variables. , 2010, The Journal of bone and joint surgery. American volume.

[16]  J. Bynum,et al.  Comparative testing by cyclic loading of rotator cuff suture anchors containing multiple high-strength sutures. , 2010, Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association.

[17]  J. Yoo,et al.  Prospective randomized clinical trial of single- versus double-row suture anchor repair in 2- to 4-cm rotator cuff tears: clinical and magnetic resonance imaging results. , 2011, Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association.

[18]  Peter J Millett,et al.  Anatomy and dimensions of rotator cuff insertions. , 2002, Journal of shoulder and elbow surgery.

[19]  Peter J Millett,et al.  Arthroscopic Single-Row versus Double-Row Suture Anchor Rotator Cuff Repair , 2005, The American journal of sports medicine.

[20]  R. Warren,et al.  Tendon-healing in a bone tunnel. A biomechanical and histological study in the dog. , 1993, The Journal of bone and joint surgery. American volume.

[21]  R E Hughes,et al.  Force Analysis of Rotator Cuff Muscles , 1996, Clinical orthopaedics and related research.

[22]  A. Grasso,et al.  Comparison between single-row and double-row rotator cuff repair: a biomechanical study , 2007, Knee Surgery, Sports Traumatology, Arthroscopy.

[23]  B. Morrey Can a Double-Row Anchorage Technique Improve Tendon Healing in Arthroscopic Rotator Cuff Repair? A Prospective, Nonrandomized, Comparative Study of Double-Row and Single-Row Anchorage Techniques With Computed Tomographic Arthrography Tendon Healing Assessment , 2008 .

[24]  A. Schulz,et al.  Arthroscopic Supraspinatus Tendon Repair with Suture-Bridging Technique , 2010, The American journal of sports medicine.

[25]  J. Fow,et al.  The supraspinatus footprint: an anatomic study of the supraspinatus insertion. , 2004, Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association.

[26]  Y. Rhee,et al.  Arthroscopic Rotator Cuff Repair Using Modified Mason-Allen Medial Row Stitch , 2012, The American journal of sports medicine.

[27]  Scott F. M. Duncan,et al.  Comparison of the Clinical Outcomes of Single- and Double-row Repairs in Rotator Cuff Tears , 2009 .

[28]  Yu-jen Chen,et al.  Knotless rotator cuff repair in an external rotation model: the importance of medial-row horizontal mattress sutures. , 2011, Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association.

[29]  Amstutz Hc,et al.  UCLA anatomic total shoulder arthroplasty. , 1981 .

[30]  Norbert P Südkamp,et al.  Tendon healing in a bone tunnel. Part II: Histologic analysis after biodegradable interference fit fixation in a model of anterior cruciate ligament reconstruction in sheep. , 2002, Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association.

[31]  Maxwell C. Park,et al.  Tendon-to-Bone Pressure Distributions at a Repaired Rotator Cuff Footprint Using Transosseous Suture and Suture Anchor Fixation Techniques , 2005, The American journal of sports medicine.

[32]  Stavros Thomopoulos,et al.  Variation of biomechanical, structural, and compositional properties along the tendon to bone insertion site. , 2003, Journal of orthopaedic research : official publication of the Orthopaedic Research Society.

[33]  C. Gerber,et al.  Suture slippage in knotless suture anchors as a potential failure mechanism in rotator cuff repair. , 2012, Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association.

[34]  C. Ahmad,et al.  Rotator cuff repair fluid extravasation characteristics are influenced by repair technique. , 2009, Journal of shoulder and elbow surgery.

[35]  F A Matsen,et al.  Repairs of the rotator cuff. Correlation of functional results with integrity of the cuff. , 1991, The Journal of bone and joint surgery. American volume.

[36]  B. Morrey Equivalent Clinical Results of Arthroscopic Single-Row and Double-Row Suture Anchor Repair for Rotator Cuff Tears: A Randomized Controlled Trial , 2008 .

[37]  J. Warner,et al.  Rotator cuff tears: the effect of the reconstruction method on three-dimensional repair site area. , 2002, Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association.

[38]  V C Mow,et al.  A standardized method for the assessment of shoulder function. , 1994, Journal of shoulder and elbow surgery.

[39]  I. Sekiya,et al.  Humeral insertion of the supraspinatus and infraspinatus. New anatomical findings regarding the footprint of the rotator cuff. Surgical technique. , 2008, The Journal of bone and joint surgery. American volume.

[40]  A. Lädermann,et al.  Long-term outcome of arthroscopic massive rotator cuff repair: the importance of double-row fixation. , 2012, Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association.

[41]  C. Guanche,et al.  Mattress double anchor footprint repair: a novel, arthroscopic rotator cuff repair technique. , 2004, Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association.

[42]  Jeffrey D Meier,et al.  The effect of double-row fixation on initial repair strength in rotator cuff repair: a biomechanical study. , 2006, Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association.

[43]  T. Wright,et al.  Suture number determines strength of rotator cuff repair. , 2012, The Journal of bone and joint surgery. American volume.

[44]  E. April,et al.  Anterior and posterior musculotendinous anatomy of the supraspinatus. , 2000, Journal of shoulder and elbow surgery.

[45]  S. Burkhart,et al.  The geometric classification of rotator cuff tears: a system linking tear pattern to treatment and prognosis. , 2010, Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association.

[46]  E. Itoi,et al.  Contact Area, Contact Pressure, and Pressure Patterns of the Tendon-Bone Interface after Rotator Cuff Repair , 2005, The American journal of sports medicine.

[47]  F. Kummer,et al.  Suture loosening and its effect on tendon fixation in knotless double-row rotator cuff repairs. , 2011, Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association.

[48]  C. T. Vangsness,et al.  An Anatomic Study of the Supraspinatus Muscle and Tendon , 2001, Clinical orthopaedics and related research.

[49]  D. P. O'connor,et al.  Ultrasound evaluation of arthroscopic full-thickness supraspinatus rotator cuff repair: single-row versus double-row suture bridge (transosseous equivalent) fixation. Results of a prospective, randomized study. , 2013, Journal of shoulder and elbow surgery.

[50]  J. Tibone,et al.  Biomechanical comparison of single‐row, double‐row, and transosseous‐equivalent repair techniques after healing in an animal rotator cuff tear model , 2013, Journal of orthopaedic research : official publication of the Orthopaedic Research Society.

[51]  A. Grasso,et al.  Single-row versus double-row arthroscopic rotator cuff repair: a prospective randomized clinical study. , 2008, Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association.

[52]  E. Itoi,et al.  Humeral attachment of the supraspinatus and infraspinatus tendons: an anatomic study. , 1998, Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association.

[53]  N. Verma,et al.  Transosseous-equivalent rotator cuff repair: a systematic review on the biomechanical importance of tying the medial row. , 2013, Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association.

[54]  W D Middleton,et al.  Natural history of asymptomatic rotator cuff tears: a longitudinal analysis of asymptomatic tears detected sonographically. , 2001, Journal of shoulder and elbow surgery.

[55]  M. Bouxsein,et al.  Three-dimensional distribution of bone density in the proximal humerus , 2003, Calcified Tissue International.

[56]  Anthony M J Bull,et al.  A biomechanical comparison of single and double-row fixation in arthroscopic rotator cuff repair. , 2006, The Journal of bone and joint surgery. American volume.

[57]  P. Millett,et al.  Clinical and structural outcomes after arthroscopic single-row versus double-row rotator cuff repair: a systematic review and meta-analysis of level I randomized clinical trials. , 2014, Journal of shoulder and elbow surgery.

[58]  D. Zurakowski,et al.  Pullout strength of suture anchors used in rotator cuff repair. , 2003, The Journal of bone and joint surgery. American volume.

[59]  Maxwell C. Park,et al.  Part I: Footprint contact characteristics for a transosseous-equivalent rotator cuff repair technique compared with a double-row repair technique. , 2007, Journal of shoulder and elbow surgery.

[60]  P. Boyer,et al.  Arthroscopic double-row cuff repair with suture-bridging: a structural and functional comparison of two techniques , 2015, Knee Surgery, Sports Traumatology, Arthroscopy.

[61]  D. Kohn,et al.  Comparable biomechanical results for a modified single-row rotator cuff reconstruction using triple-loaded suture anchors versus a suture-bridging double-row repair. , 2012, Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association.

[62]  C. Charousset,et al.  Can a Double-Row Anchorage Technique Improve Tendon Healing in Arthroscopic Rotator Cuff Repair? , 2007, The American journal of sports medicine.

[63]  H. Takahashi-Iwanaga,et al.  Early anchoring collagen fibers at the bone—tendon interface are conducted by woven bone formation: light microscope and scanning electron microscope observation using a canine model , 2001, Journal of orthopaedic research : official publication of the Orthopaedic Research Society.