title: Clinical and structural outcomes after arthroscopic single-row versus double-row rotator cuff repair: a systematic review and meta-analysis of level I randomized clinical trials.
abstract: BACKGROUND
  The purpose of this study was to perform a systematic review and meta-analysis of all available level I randomized controlled trials comparing single-row with double-row repair to statistically compare clinical outcomes and imaging-diagnosed re-tear rates.
  
  
  METHODS
  A literature search was undertaken to identify all level I randomized controlled trials comparing structural or clinical outcomes after single-row versus double-row rotator cuff repair. Clinical outcomes measures included in the meta-analysis were the American Shoulder and Elbow Surgeons, University of California-Los Angeles, and Constant scores; structural outcomes included imaging-confirmed re-tears. Meta-analyses compared raw mean differences in outcomes measures and relative risk ratios for imaging-diagnosed re-tears after single-row or double-row repairs by a random-effects model.
  
  
  RESULTS
  The literature search identified a total of 7 studies that were included in the meta-analysis. There were no significant differences in preoperative to postoperative change in American Shoulder and Elbow Surgeons, University of California-Los Angeles, or Constant scores between the single-row and double-row groups (P = .440, .116, and .156, respectively). The overall re-tear rate was 25.9% (68/263) in the single-row group and 14.2% (37/261) in the double-row group. There was a statistically significant increased risk of sustaining an imaging-proven re-tear of any type in the single-row group (relative risk, 1.76 [95% confidence interval, 1.25-2.48]; P = .001), with partial-thickness re-tears accounting for the majority of this difference (relative risk, 1.99 [95% confidence interval, 1.40-3.82]; P = .039).
  
  
  CONCLUSIONS
  Single-row repairs resulted in significantly higher re-tear rates compared with double-row repairs, especially with regard to partial-thickness re-tears. However, there were no detectable differences in improvement in outcomes scores between single-row and double-row repairs.
authors.affiliation: Steadman Philippon Research Institute, Vail, CO, USA. Electronic address: drmillett@thesteadmanclinic.com.
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Millett
authors.affiliation: Steadman Philippon Research Institute, Vail, CO, USA.
authors.forename: Ryan J
authors.initials: RJ
authors.lastname: Warth
authors.affiliation: Steadman Philippon Research Institute, Vail, CO, USA.
authors.forename: Grant J
authors.initials: GJ
authors.lastname: Dornan
authors.affiliation: Steadman Philippon Research Institute, Vail, CO, USA.
authors.forename: Jared T
authors.initials: JT
authors.lastname: Lee
authors.affiliation: Steadman Philippon Research Institute, Vail, CO, USA.
authors.forename: Ulrich J
authors.initials: UJ
authors.lastname: Spiegl
mesh_terms: D001182:Arthroscopy / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016032:Randomized Controlled Trials as Topic; D012008:Recurrence; D017006:Rotator Cuff / Q000601:surgery*; D000070636:Rotator Cuff Injuries; D013536:Suture Techniques; D013708:Tendon Injuries / Q000601:surgery*; D016896:Treatment Outcome
keywords: Single row; double row; meta-analysis; rotator cuff repair; systematic review