This review compares single-row and double-row suture techniques for arthroscopic rotator cuff repair. It combines a review of biomechanical bench studies with a systematic review of Level-I and II clinical trials. The goal is to determine whether biomechanically stronger constructs actually produce better clinical outcomes.
The practical rule from this review: match the construct to the tear. For most tears, single-row and double-row repair give equivalent functional outcomes, so single-row is reasonable and faster (about 9 minutes shorter operative time). For large tears greater than 3 cm, double-row improves healing rates and strength, so favor it when tear size and tissue allow.
The deeper lesson is that biomechanical superiority on the bench does not reliably translate to clinical outcome. The most common failure is the tendon pulling through the suture, which means tissue quality, tear pattern recognition, and anatomic footprint reduction drive healing more than the specific stitch.
When you cannot mobilize the cuff to a tension-free anatomic position, no suture configuration will rescue the repair.
This review compares single-row and double-row suture techniques for arthroscopic rotator cuff repair. It combines a review of biomechanical bench studies with a systematic review of Level-I and II clinical trials. The goal is to determine whether biomechanically stronger constructs actually produce better clinical outcomes.
The practical rule from this review: match the construct to the tear. For most tears, single-row and double-row repair give equivalent functional outcomes, so single-row is reasonable and faster (about 9 minutes shorter operative time). For large tears greater than 3 cm, double-row improves healing rates and strength, so favor it when tear size and tissue allow.
The deeper lesson is that biomechanical superiority on the bench does not reliably translate to clinical outcome. The most common failure is the tendon pulling through the suture, which means tissue quality, tear pattern recognition, and anatomic footprint reduction drive healing more than the specific stitch.
When you cannot mobilize the cuff to a tension-free anatomic position, no suture configuration will rescue the repair.