Long-term Results of Arthroscopic Rotator Cuff Repair: A Follow-up Study Comparing Single-Row Versus Double-Row Fixation Techniques

Abstract

Background: Arthroscopic rotator cuff repair (RCR) with suture anchor–based fixation techniques has replaced former open and mini-open approaches. Nevertheless, long-term studies are scarce, and lack of knowledge exists about whether single-row (SR) or double-row (DR) methods are superior in clinical and anatomic results. Purpose: To analyze long-term results after arthroscopic RCR in patients with symptomatic rotator cuff tears and to compare functional and radiographic outcomes between SR and DR repair techniques at least 10 years after surgery. Study Design: Cohort study; Level of evidence, 3. Methods: Between 2005 and 2006, 40 patients with a symptomatic full-thickness rotator cuff tear (supraspinatus tendon tear with or without a tear of the infraspinatus tendon) underwent arthroscopic RCR with either an SR repair with a modified Mason-Allen suture–grasping technique (n = 20) or a DR repair with a suture bridge fixation technique (n = 20). All patients were enrolled in a long-term clinical evaluation, with the Constant score (CS) as the primary outcome measure. Furthermore, an ultrasound examination was performed to assess tendon integrity and conventional radiographs to evaluate secondary glenohumeral osteoarthritis. Results: A total of 27 patients, of whom 16 were treated with an SR repair and 11 with a DR repair, were followed up after a mean ± SD period of 12 ± 1 years (range, 11-14 years). Five patients underwent revision surgery on the affected shoulder during follow-up period, which led to 22 patients being included. The overall CS remained stable at final follow-up when compared with short-term follow-up (81 ± 8 vs 83 ± 19 points; P = .600). An increasing number of full-thickness retears were found: 6 of 22 (27%) at 2 years and 9 of 20 (45%) at 12 years after surgery. While repair failure negatively affected clinical results as shown by the CS ( P < .05), no significant difference was found between the fixation techniques ( P = .456). In general, progressive osteoarthritic changes were observed, with tendon integrity as a key determinant. Conclusion: Arthroscopic RCR with either an SR or a DR fixation technique provided good clinical long-term results. Repair failure was high, with negative effects on clinical results and the progression of secondary glenohumeral osteoarthritis. While DR repair slightly enhanced tendon integrity at long-term follow-up, no clinical superiority to SR repair was found.

Minimum 10-Year Outcomes of Primary Arthroscopic Transosseous-Equivalent Double-Row Rotator Cuff Repair

“…MRI was obtained at the 2-year follow-up and revealed full-thickness retears in 6 of 22 patients (27%) who did not undergo revision, while 9 of 20 patients (45%) had full retears at 12 years postoperatively. When compared with the current study, Plachel et al's 15 group has fewer patients (11 vs 69) but a similar follow-up time and technique. Their revision rate was also higher (9.1% vs 5.5%) than in the current study, but the small sample size also makes this comparison difficult.…”

“…This value is much lower than in previously documented literature on rotator cuff repair. 8,9,15,16 These results are quite promising, although there were no long-term structural data. It is possible that there were patients in our cohort with minimally symptomatic or asymptomatic retears that did not require further surgery; however, the long-term nature of the study makes these types of failure less significant.…”

“…In another more recent study by Plachel et al 15 where modern techniques were used, 16 single-row vs 11 double-row rotator cuff repairs were compared at 11-to 14year follow-up. Five patients underwent revision, making the overall revision rate 8.1%.…”

Current concepts in the evolution of arthroscopic rotator cuff repair

“…When comparing various techniques in the clinical setting, there have been at least 11 studies that have directly compared single-vs. double-row techniques for clinical and functional outcomes. 3,21,26,41,42,46,60,62,66,78,84 Of these studies, 8 of 11 showed no difference between single-and double-row repairs. Two studies 66,78 noted differences between groups, but these were for large tears (>3cm) only.…”

“…Regarding studies that specifically compared double-vs. singlerow repair for healing rates of RCR, 5 of 8 found no difference in healing. 21,41,60,66,84 For the 3 studies that did demonstrate a difference, 26,42,62 all favored the double-row construct. Gartsman 42 in a comparative study of 83 patients at 10 months found double-row suture bridge repair rates of failure at 7% which was significantly lower than the 25% rate of his single-row repairs with simple sutures.…”