Review Question - QID 219987

This 45-year-old male sustained a traumatic right rotator cuff tear that was subsequently repaired with a double-row construct. Compared to single-row constructs, double-row repairs demonstrate similar short- and mid-term functional outcomes (Answer 1).

Rotator cuff tears (RCT) are ubiquitous conditions encountered in clinical practice. While RCTs are often treated nonoperatively, those who sustain the injury secondary to trauma or remain symptomatic following nonoperative treatment often require repair. Several repair techniques have been described, with the literature largely remaining inconclusive regarding which technique is best. Double-row repairs, which include mattress sutures in the medial row and simple sutures in the lateral row, purportedly result in improved tendinous healing secondary to larger contact area, improved repair strength and load to failure, and decreased risk for retear (though less decisively in tears less than three centimeters). Clinically, double-row and single-row techniques demonstrate little difference in the short and mid-term. However, a recent randomized controlled trial reported that double-row constructs may improve function over the long term, though the clinical significance of this has yet to be fully elucidated.

Hantes et al. performed a prospective study comparing mid-term (mean follow-up: 46 months) radiological and clinical outcomes of those undergoing either single-row (n=34) or double-row (n=32) repair for their RCTs. Higher tendon healing was noted with the double-row group (84 vs. 61%, p<0.05), while no difference was observed in functional outcomes. The authors concluded that double-row repair should be considered in those under 55 years of age with medium to large RCTs.

Chen et al. performed a systematic review and meta-analysis of 12 studies comparing single-row versus double-row repair techniques. In those with less than three centimeters of retraction, the two repair techniques had no functional and structural differences. However, those with RCTs greater than three centimeters of retraction had similar function, but improved tendon healing when treated with a double-row construct. The authors conclude that double-row techniques may be better suited for tears greater than three centimeters, as they appear to enhance healing rates.

Lapner et al. performed a multicenter, randomized controlled trial examining the long-term effects of single- versus double-row repair techniques (mean follow-up: 10 years; n=90). The authors found that functional scores were significantly higher in the double-row repair group. Function declined in the single-row group from years two to ten, while remaining nearly the same in the double-row group. The authors concluded that although the double-row repair group exhibits significantly higher functional scores long-term, this finding may not be clinically relevant.

Figure A represents a T2-weighted coronal image demonstrating a small rotator cuff tear. Figure B is an illustration showing a double-row repair construct. Figure C is an illustration showing a single-row repair construct.

Incorrect Answers:
Answer 2: the double-row technique has demonstrated decreased risk of retear, particularly in RCTs with greater than three centimeters of retraction.
Answer 3: the double-row technique creates a larger footprint for bony healing, and is believed to improve overall rates of healing.
Answer 4: double-row repairs at the very least perform similarly, if not better than single-row repair in the long term.
Answer 5: the double-row technique exhibits enhanced repair strength.