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Comparison of the Clinical Outcomes of Single- and Double-row Repairs in Rotator Cuff Tears

Jin-Young Park, MD, PhD^,*, Sang-Hoon Lhee, MD^,*, Jin-Hyung Choi, MD, Hong-Keun Park, MD, Je-Wook Yu, MD and Joong-Bae Seo, PhD

From the Shoulder, Elbow and Sports Service, Department of Orthopaedic Surgery, Konkuk University School of Medicine, Seoul, Korea, and the Department of Orthopaedic Surgery, Dankook University College of Medicine, Chungnam, Korea

^* Address correspondence to: Jin-Young Park (drpark{at}chol.com) or Sang-Hoon Lhee (sanghoon.lhee{at}gmail.com).

Background: Although research has demonstrated the superiority of double-row rotator cuff repair over single-row methods from a biological and mechanical point of view, few studies have compared clinical outcome of the 2 methods, and no articles have been published describing the superiority of double-row methods in clinical aspects.

Hypothesis: Arthroscopic double-row repair of a rotator cuff tear has superior clinical outcome to single-row repair.

Study Design: Cohort study; Level of evidence, 2.

Methods: The study included 78 patients operated on for full-thickness rotator cuff tears between May 2002 and May 2004. A single-row fixation method was used in the first consecutive 40 patients, and a double-row fixation method was used in the next consecutive 38 patients. The mean age at surgery was 56 years. At 2 years after surgery, final evaluation was done with American Shoulder and Elbow Surgeons and Constant scoring systems and the Shoulder Strength Index. The Shoulder Strength Index is a new evaluation method to estimate relative shoulder strength compared with the unaffected shoulder.

Results: At final follow-up, the average American Shoulder and Elbow Surgeons scores were 91.6 in the single-row group and 93.0 in the double-row group. The Constant score was 76.7 in the single-row group and 80.0 in the double-row group. Functional outcome was improved in both groups after surgery, but there was no significant difference between the 2 groups. When the patients were further divided by size of tear, there was still no difference between the repair techniques in the patients with small to medium (<3 cm) tears. However, in patients with large to massive tears (>3 cm), the American Shoulder and Elbow Surgeons and Constant scores and Shoulder Strength Index were all significantly better in the group that had double-row repair.

Conclusion: Small to medium rotator cuff tears should be repaired with the single-row method, and large to massive tears should be repaired with the double-row method.

Key Words: rotator cuff tear • single-row repair • double-row repair • Shoulder Strength Index (SSI)