title: Does double-row rotator cuff repair improve functional outcome of patients compared with single-row technique? A systematic review.
abstract: BACKGROUND
  The advantage of single-row versus double-row arthroscopic rotator cuff repair techniques has been a controversial issue in sports medicine and shoulder surgery. There is biomechanical evidence that double-row techniques are superior to single-row techniques; however, there is no clinical evidence that the double-row technique provides an improved functional outcome.
  
  
  OBJECTIVE
  When compared with single-row rotator cuff repair, double-row fixation, although biomechanically superior, has no clinical benefit with respect to retear rate or improved functional outcome.
  
  
  METHODS
  Systematic review.
  
  
  METHODS
  The authors reviewed prospective studies of level I or II clinical evidence that compared the efficacy of single- and double-row rotator cuff repairs. Functional outcome scores included the American Shoulder and Elbow Surgeons (ASES) shoulder scale, the Constant shoulder score, and the University of California, Los Angeles (UCLA) shoulder rating scale. Radiographic failures and complications were also analyzed. A test of heterogeneity for patient demographics was also performed to determine if there were differences in the patient profiles across the included studies.
  
  
  RESULTS
  Seven studies fulfilled our inclusion criteria. The test of heterogeneity across these studies showed no differences. The functional ASES, Constant, and UCLA outcome scores revealed no difference between single- and double-row rotator cuff repairs. The total retear rate, which included both complete and partial retears, was 43.1% for the single-row repair and 27.2% for the double-row repair (P = .057), representing a trend toward higher failures in the single-row group.
  
  
  CONCLUSIONS
  Through a comprehensive literature search and meta-analysis of current arthroscopic rotator cuff repairs, we found that the single-row repairs did not differ from the double-row repairs in functional outcome scores. The double-row repairs revealed a trend toward a lower radiographic proven retear rate, although the data did not reach statistical significance. There may be a concerning trend toward higher retear rates in patients undergoing a single-row repair, but further studies are required.
authors.affiliation: Department of Orthopaedic Surgery and Sports Medicine, Boston University School of Medicine, Boston, MA, USA.
authors.forename: Alexander M
authors.initials: AM
authors.lastname: DeHaan
authors.forename: Thomas W
authors.initials: TW
authors.lastname: Axelrad
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Kaye
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Silvestri
authors.forename: Brian
authors.initials: B
authors.lastname: Puskas
authors.forename: Timothy E
authors.initials: TE
authors.lastname: Foster
mesh_terms: D001134:Arm Injuries / Q000534:rehabilitation / Q000601:surgery*; D001182:Arthroscopy / Q000379:methods* / Q000534:rehabilitation; D006801:Humans; D011183:Postoperative Complications; D020127:Recovery of Function; D012008:Recurrence; D017006:Rotator Cuff / Q000601:surgery; D000070636:Rotator Cuff Injuries; D013708:Tendon Injuries / Q000534:rehabilitation / Q000601:surgery*; D016896:Treatment Outcome