title: Is double-row rotator cuff repair clinically superior to single-row rotator cuff repair: a systematic review of overlapping meta-analyses.
abstract: OBJECTIVE
  Multiple meta-analyses of randomized clinical trials, the highest available level of evidence, have been conducted to determine whether double-row (DR) or single-row (SR) rotator cuff repair (RCR) provides superior clinical outcomes and structural healing; however, results are discordant. The purpose of this study was to conduct a systematic review of meta-analyses comparing SR and DR RCR to elucidate the cause of discordance and to determine which meta-analysis provides the current best available evidence.
  
  
  METHODS
  In this study we evaluated available scientific support for SR versus DR RCR by systematically reviewing the literature for published meta-analyses. Data were extracted from these meta-analyses for patient outcomes and structural healing. Meta-analysis quality was assessed with the Oxman-Guyatt and Quality of Reporting of Meta-analyses (QUOROM) systems. The Jadad algorithm was then applied to determine which meta-analyses provided the highest level of evidence.
  
  
  RESULTS
  Eight meta-analyses met the eligibility criteria: 4 including Level I evidence and 4 including both Level I and Level II evidence. Six meta-analyses found no differences between SR and DR RCR for patient outcomes, whereas 2 favored DR RCR for tears greater than 3 cm. Two meta-analyses found no structural healing differences between SR and DR RCR, whereas 3 found DR repair to be superior for tears greater than 3 cm and 2 found DR repair to be superior for all tears. Four meta-analyses had low Oxman-Guyatt scores (<3) indicative of major flaws. After application of the Jadad algorithm, 3 concordant high-quality meta-analyses were selected, all of which found significantly better structural healing with DR compared with SR RCR.
  
  
  CONCLUSIONS
  According to this systematic review of overlapping meta-analyses comparing SR and DR RCR, the current highest level of evidence suggests that DR RCR provides superior structural healing to SR RCR.
  
  
  METHODS
  Level II, systematic review of Level I and II studies.
authors.affiliation: Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A.. Electronic address: mascarer@hotmail.com.
authors.forename: Randy
authors.initials: R
authors.lastname: Mascarenhas
authors.affiliation: Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A.
authors.forename: Peter N
authors.initials: PN
authors.lastname: Chalmers
authors.affiliation: College of Physicians and Surgeons, Columbia University, New York, New York, U.S.A.
authors.forename: Eli T
authors.initials: ET
authors.lastname: Sayegh
authors.affiliation: Department of Orthopaedic Surgery, McMaster University, Hamilton, Ontario, Canada.
authors.forename: Mohit
authors.initials: M
authors.lastname: Bhandari
authors.affiliation: Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A.
authors.forename: Nikhil N
authors.initials: NN
authors.lastname: Verma
authors.affiliation: Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A.
authors.forename: Brian J
authors.initials: BJ
authors.lastname: Cole
authors.affiliation: Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A.
authors.forename: Anthony A
authors.initials: AA
authors.lastname: Romeo
mesh_terms: D019317:Evidence-Based Medicine / Q000592:standards; D006801:Humans; D015201:Meta-Analysis as Topic; D016032:Randomized Controlled Trials as Topic; D017006:Rotator Cuff / Q000601:surgery*; D053441:Suture Anchors; D016896:Treatment Outcome; D014945:Wound Healing