Strong evidence supports lower re-tear rates after double row repair compared to single row vertical mattress repair when evaluating for both partial and full thickness retears after primary repair; however, when evaluating the data for only full thickness retears, limited evidence does not support lower re-tear rates after double row primary repair.

Management of Rotator Cuff Injuries
Endorsed by: AANA, ASES, AOSSM, ASSET, APTA
Strong Evidence STRONG EVIDENCE
Rationale
Eight high quality randomized controlled trials (RCTs) utilized magnetic resonance imaging (MRI) reported the re-tear rates after single row versus double row repair in patients with full thickness rotator cuff tears. (Barber 2016, Burks 2009, Franceschi 2016, Franceschi 2007, Koh 2011, Lapner 2012, Ma 2012, Carbonel 2012). 

When the re-tear rates include both partial and full thickness tears, a meta-analysis of the pooled data from these eight RCTs identified the relative risk (RR = 0.58 (0.43-0.78)) of re-tear is significantly lower after double row repair compared to single row repair for full thickness rotator cuff tears.  Thus, there is strong evidence that supports lower re-tear rates (partial and full thickness) after double row repair compared to single row vertical mattress repair for full thickness rotator cuff tears.

However, when re-tears are defined as full thickness only, the relative risk (RR = 0.71 (0.45-1.11)) is 0.71 with a wider confidence interval (0.45 – 1.11) which indicates limited evidence to support lower risk of re-tear (Full thickness) after double row compared to single row repairs.

Risks and Harms of Implementing this Recommendation
There is no harm to patients by implementing this recommendation.  However, partial and full thickness re-tear rates may be higher after single vertical mattress repair compared to double row in patients with full thickness rotator cuff tears.  The clinical significance is unknown.

Future Research
Future research should be performed to evaluate for failure rates on imaging and reoperation rates between single row compared to double row repair for full thickness rotator cuff tears.  Research also needs to be done to better identify the clinical significance of a partial thickness re-tear after arthroscopic rotator cuff repair.
  1. (107) Franceschi F, Ruzzini L, Longo UG et al. Equivalent clinical results of arthroscopic single-row and double-row suture anchor repair for rotator cuff tears: a randomized controlled trial. Am J Sports Med 2007;35(8):1254-1260.
  2. Barber, F. A. Triple-Loaded Single-Row Versus Suture-Bridge Double-Row Rotator Cuff Tendon Repair With Platelet-Rich Plasma Fibrin Membrane: A Randomized Controlled Trial. Arthroscopy 2016; 5: 753-61
  3. Burks, R. T., Crim, J., Brown, N., Fink, B., Greis, P. E. A prospective randomized clinical trial comparing arthroscopic single- and double-row rotator cuff repair: magnetic resonance imaging and early clinical evaluation. American Journal of Sports Medicine 2009; 4: 674-82
  4. Carbonel, I., Martinez, A. A., Calvo, A., Ripalda, J., Herrera, A. Single-row versus double-row arthroscopic repair in the treatment of rotator cuff tears: a prospective randomized clinical study. International Orthopaedics 2012; 9: 1877-83
  5. Franceschi, F, Papalia, R, Franceschetti, E, Palumbo, A, Buono, A, Paciotti, M, Maffulli, N, Denaro, V Double-Row Repair Lowers the Retear Risk After Accelerated Rehabilitation. American Journal of Sports Medicine 2016; 4: 948-956
  6. Koh, K. H., Kang, K. C., Lim, T. K., Shon, M. S., Yoo, J. C. Prospective randomized clinical trial of single- versus double-row suture anchor repair in 2- to 4-cm rotator cuff tears: clinical and magnetic resonance imaging results. Arthroscopy 2011; 4: 453-62
  7. Lapner, Pl, Sabri, E, Rakhra, K, McRae, S, Leiter, J, Bell, K, Macdonald, P A multicenter randomized controlled trial comparing single-row with double-row fixation in arthroscopic rotator cuff repair. The Journal of bone and joint surgery. American volume 2012; 14: 1249-
  8. Ma, Hl, Chiang, Er, Wu, Ht, Hung, Sc, Wang, St, Liu, Cl, Chen, Th Clinical outcome and imaging of arthroscopic single-row and double-row rotator cuff repair: a prospective randomized trial. Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association 2012; 1: 16-24