Arthroscopic Single-Row Versus Double-Row Repair for Full-Thickness Posterosuperior Rotator Cuff Tears

Single- versus double-row repair for full-thickness rotator cuff tears using suture anchors. A systematic review and meta-analysis of basic biomechanical studies

“…In contrast, for larger tears above 3 cm double-row repair demonstrated superiority compared to the single-row technique [27]. This difference has been attributed to greater compression of the repair and a larger footprint area, which has been shown to increase the healing potential [1,24]. However, it is also possible that the absolute number of sutures, rather than the repair technique, is the common denominator for tendon healing.…”

“…Gap formation can potentially compromise tendon-bone healing, and was found to be one of the predictors for poor healing outcomes [1,29]. However, there is no clear consensus as to what is the exact value for gap formation or elongation to define a failure [29].…”

“…Despite these significant findings, the results of these studies should be interpreted with caution. In addition, several authors have shown that the numbers of sutures passing through the tendon was the most important determinant of gap formation regardless of whether a single-or double-row repair was performed [1,24,28]. This suggests surgical technique was only one of the factors determining a successful outcome following surgery.…”

“…Many factors contribute to successful repair of the rotator cuff. Anatomic factors are one of the key considerations, which include restoration of the footprint contact area [1], tendon and bone quality [2], appropriate compression of the tendon on the footprint to facilitate healing [3], and minimized motion at the bone-tendon interface [4]. Likewise, intrinsic factors such as decreased vascularity, hypoxia, atrophy, fibrocartilaginous changes, and fatty infiltration of the torn rotator cuff muscles have also been associated with inferior outcomes [2].…”

“…Initial fixation plays an important role and may be critical in achieving successful healing [2,5]. Numerous surgical techniques have been described for the repair of rotator cuff injuries, including fixation using single-or double-row suture anchor techniques, transosseous tunnels, or newer configurations such as transosseous equivalent (TOE) or knotless techniques [1]. Several biomechanical studies have demonstrated that double-row suture repair recreates the native footprint more closely resulting in significantly higher loads to failure and decreased gap formation under tensile loading [6][7][8].…”