title: Functional Outcomes After Double-Row Versus Single-Row Rotator Cuff Repair: A Prospective Randomized Trial.
abstract: BACKGROUND
  The functional benefits of double-row (DR) versus single-row (SR) rotator cuff repair are not clearly established.
  
  
  OBJECTIVE
  To examine the effect of DR versus SR rotator cuff repair on functional outcomes and strength recovery in patients with full-thickness tears.
  
  
  METHODS
  Randomized controlled trial; Level of evidence, 2.
  
  
  METHODS
  Forty-nine patients were randomized to DR or SR repairs; 36 patients (13 women, 23 men; mean age, 62 ± 7 years; 20 SR, 16 DR) were assessed at a mean 2.2 ± 1.6 years after surgery (range, 1-7 years; tear size: 17 medium, 13 large, 9 massive). The following data were recorded prior to surgery and at follow-up: Penn shoulder score, American Shoulder and Elbow Surgeons (ASES), and Simple Shoulder Test (SST) results; range of motion (ROM) for shoulder flexion, external rotation (ER) at 0° and 90° of abduction, and internal rotation (IR) at 90° of abduction; and shoulder strength (Lafayette manual muscle tester) in empty- and full-can tests, abduction, and ER at 0° of abduction. Treatment (SR vs DR) × time (pre- vs postoperative) mixed-model analysis of variance was used to assess the effect of rotator cuff repair.
  
  
  RESULTS
  Rotator cuff repair markedly improved Penn, ASES, and SST scores (P< .001), with similar improvement between SR and DR repairs (treatment × time,P= .38-.10) and excellent scores at follow-up (DR vs SR: Penn, 91 ± 11 vs 92 ± 11 [P= .73]; ASES, 87 ± 12 vs 92 ± 12 [P= .21]; SST, 11.4 ± 1.0 vs 11.3 ± 1.0 [P= .76]). Patients with DR repairs lost ER ROM at 0° of abduction (preoperative to final follow-up, 7° ± 10° loss [P= .013]). ER ROM did not significantly change with SR repair (5° ± 14° gain,P= .16; treatment by time,P= .008). This effect was not apparent for ER ROM at 90° of abduction (treatment × time,P= .26). IR ROM improved from preoperative to final follow-up (P< .01; SR, 17° ± 27°; DR, 7° ± 21°; treatment × time,P= .23). Rotator cuff repair markedly improved strength in empty-can (54%), full-can (66%), abduction (47%), and ER (54%) strength (allP< .001), with no difference between SR and DR repairs (P= .23-.75). All clinical tests with the exception of the lift-off test were normalized at follow-up (P< .05).
  
  
  CONCLUSIONS
  Outcomes were not different between SR or DR repair, with generally excellent outcomes for both groups. Rotator cuff repair and subsequent rehabilitation markedly improved shoulder strength.
authors.affiliation: Nicholas Institute of Sports Medicine and Athletic Trauma, Lenox Hill Hospital, New York, New York, USA.
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Nicholas
authors.affiliation: Nicholas Institute of Sports Medicine and Athletic Trauma, Lenox Hill Hospital, New York, New York, USA.
authors.forename: Steven J
authors.initials: SJ
authors.lastname: Lee
authors.affiliation: Nicholas Institute of Sports Medicine and Athletic Trauma, Lenox Hill Hospital, New York, New York, USA.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Mullaney
authors.affiliation: Nicholas Institute of Sports Medicine and Athletic Trauma, Lenox Hill Hospital, New York, New York, USA.
authors.forename: Timothy F
authors.initials: TF
authors.lastname: Tyler
authors.affiliation: Nicholas Institute of Sports Medicine and Athletic Trauma, Lenox Hill Hospital, New York, New York, USA.
authors.forename: Takumi
authors.initials: T
authors.lastname: Fukunaga
authors.affiliation: Nicholas Institute of Sports Medicine and Athletic Trauma, Lenox Hill Hospital, New York, New York, USA.
authors.forename: Christopher D
authors.initials: CD
authors.lastname: Johnson
authors.affiliation: Nicholas Institute of Sports Medicine and Athletic Trauma, Lenox Hill Hospital, New York, New York, USA.
authors.forename: Malachy P
authors.initials: MP
authors.lastname: McHugh
keywords: empty-can test; full-thickness tear; handheld dynamometer; shoulder strength