Double-Row Repair Improves Outcomes for Large Rotator Cuff Tears but Offers No Advantage for Small-to-Medium Tears: A Systematic Review and Meta-analysis of Randomized Controlled Trials.

PURPOSE: To systematically review the extant literature for randomized controlled trials comparing the primary outcome of retear rates and secondary outcomes, including functional scores, range of motion, and operative times, between single-row (SR) and double-row (DR) arthroscopic rotator cuff repairs.

METHODS

PubMed, Cochrane Library, Embase, and Web of Science were searched for studies comparing the clinical outcomes of patients who underwent arthroscopic rotator cuff repair with the SR or DR technique. Eighteen randomized controlled trials were identified. The retear rates, functional scores, range of motion, and operative times were analyzed. A subgroup analysis was conducted based on the tear size (30 mm).

RESULTS

Eighteen studies involving 1308 patients were included. The DR group had better University of California Los Angeles score (standardized mean difference [SMD] = -0.28; 95% confidence intervals (CI), -0.44, -0.12; I2 = 7%), enhanced forward flexion (standardized mean difference = -0.38; 95% CI, -0.58, -0.19; I2 = 26%), and a lower overall (OR = 1.88; 95% CI, 1.33, 2.66; I2 = 27%) and partial-thickness (OR = 2.81; 95% CI, 1.50, 5.24; I2 = 3%) retear rate than the SR group. Conversely, the SR group exhibited a reduced operation time (standardized mean difference = -0.74; 95% CI, -1.04, -0.43; I2 = 40%). For tears >30 mm, DR repair was superior to SR repair in American Shoulder and Elbow Surgeons score, University of California Los Angeles score, and retear rates. However, for tears <30 mm, no significant between-group difference was noted.

CONCLUSIONS

The DR repair exhibited superiority in retear rates, University of California Los Angeles scores, and forward flexion, despite longer operative times. For tears ≥30 mm, the use of DR repair consistently yielded superior functional and radiological outcomes. However, for tears <30 mm, studies have shown that SR and DR repairs have comparable clinical results and retear rates. This suggests that DR repair is more recommended than SR repair for large tears, but the more efficient SR repair is a suitable option for tears ranging from small to medium in size.

LEVEL OF EVIDENCE: Level II, meta-analysis of Level I and II studies.