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The construct in Figure C results in improved forward elevation and external rotation at long-term follow up
5%
39/794
The construct in Figure B is more costly than that in Figure C
1%
8/794
The construct in Figure B results in less post-operative pain and faster recovery
The construct in Figure C results in improved healing and lower re-tear rates
82%
648/794
The construct in Figure B results in less intra-operative blood loss
7%
55/794
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Double-row fixation (Figure C) leads to similar improvement in function and pain compared with single-row fixation (Figure B), but with a higher healing rate and a lower re-tear rate than single-row fixation.Rotator cuff tears are a very common source of shoulder pain and decreased motion that can occur due to both traumatic injuries in young patients as well as degenerative disease in the elderly patient. Treatment can be non-operative or operative depending on the chronicity of symptoms, severity of the tear, degree of muscle fatty atrophy, patient age, and patient activity demands. The principles of rotator cuff surgery involve a tension-free repair and footprint restoration with the hypothesis that a larger footprint will improve healing and the mechanical strength of the rotator cuff repair. Double-row suture techniques (mattress sutures in the medial row and simple sutures in the lateral row) have been shown to create a more anatomic repair of the footprint, decreasing re-tear rates and improving healing rates.Lapner et al. published a systematic review and meta-analysis on the treatment of rotator cuff tears. The authors included a total of 15 RCTs (n = 1096 randomized patients) comparing single-row (SR) vs. double-row (DR) fixation and found no significant standardized mean differences in function or pain, but did find a difference in re-tear rates in favor of DR compared with SR fixation. They concluded that DR fixation leads to similar improvement in function and pain compared with SR fixation but results in a higher healing rate. Xu et al. published a network meta-analysis and systematic review of the clinical effect of arthroscopic rotator cuff repair techniques. The authors included 21 trials comprising 1815 shoulders undergoing either single-row (SR)m double-row (DR), or speed-bride (SB) repair, with the primary outcome measure being the re-tear rate and the secondary outcome measures including the constant score and the range of motion (forward flexion and external rotation). They found that SB repairs might be the best choice to improve the postoperative recovery of function and decrease the retear rate.Figure A is a coronal STIR MRI sequence showing a high-grade partial thickness bursal-sided insertional tear of the supraspinatus. Figure B is a graphic showing a single-row rotator cuff repair with a row of medial anchors only (red dots). Figure C is a graphic showing a double-row rotator cuff repair with medial (red dots) and lateral (blue dots) row anchors. Incorrects Answers: Answers 1 and 3: The current literature has not shown any significant difference in patient-reported outcomes or functional outcomes for single- vs. double-row repairs. Answer 2: Given that the double-row construct in Figure C uses more anchors, it would be expected to be more costly than a single-row repair (Figure B). Answer 5: There is no significant difference in blood loss between the two techniques.
3.4
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