Which method of rotator cuff repair leads to the highest rate of structural healing? A systematic review.
BACKGROUND
The purpose of rotator cuff repair is to diminish pain and restore function, and this most predictably occurs when the tendon is demonstrated to heal. Recent improvements in repair methods have led to improved biomechanical performance, but this has not yet been demonstrated to result in higher healing rates. The purpose of our study was to determine whether different repair methods resulted in different rates of recurrent tearing after surgery.


OBJECTIVE
We hypothesized that (1) the rotator cuff repair method will not affect retear rate, and (2) the surgical approach will not affect the retear rate for a given repair method.


METHODS
Systematic review of the literature.


METHODS
The literature was systematically searched to find articles reporting imaging study assessment of structural healing rates after rotator cuff repair, with data stratified according to tear size. Retear rates were compared for transosseous (TO), single-row suture anchor (SA), double-row suture anchor (DA), and suture bridge (SB) repair methods, as well as for open (O), miniopen (MO), and arthroscopic (A) approaches.


RESULTS
Retear rates were available for 1252 repairs collected from 23 studies. Retear rates were significantly lower for double-row repairs when compared with TO or SA for all tears greater than 1 cm and ranged from 7% for tears less than 1 cm to 41% for tears greater than 5 cm, in comparison with retear rates for single-row techniques (TO and SA) of 17% to 69% for tears less than 1 cm and greater than 5 cm, respectively. There was no significant difference in retear rates between TO and SA repair methods or between arthroscopic and nonarthroscopic approaches for any tear size.


CONCLUSIONS
Double-row repair methods lead to significantly lower retear rates when compared with single-row methods for tears greater than 1 cm. Surgical approach has no significant effect on retear rate.
Duquin
Thomas R
TR
Department of Orthopaedic Surgery, University at Buffalo, Buffalo, NY, USA.
Buyea
Cathy
C
Bisson
Leslie J
LJ
D000368:Aged; D001182:Arthroscopy / Q000379:methods*; D006801:Humans; D008875:Middle Aged; D016032:Randomized Controlled Trials as Topic; D016059:Range of Motion, Articular; D019651:Plastic Surgery Procedures; D020127:Recovery of Function; D017006:Rotator Cuff / Q000601:surgery*; D000070636:Rotator Cuff Injuries; D012422:Rupture, Spontaneous; D053441:Suture Anchors; D013536:Suture Techniques; D016896:Treatment Outcome; D014945:Wound Healing