This Level 1 RCT compared arthroscopic single-row versus double-row suture anchor repair for large and massive rotator cuff tears. Sixty patients were randomized, with 52 completing 2-year follow-up including MR arthrography. The question: does the biomechanical advantage of double-row repair translate into better clinical or imaging outcomes?
The biomechanical case for double-row repair is compelling on paper: it restores more footprint area, reduces gap formation, and improves construct stiffness in cadaveric models. This trial tests whether those lab advantages matter to the patient.
They don't — at least not at 2 years. When you have a large or massive but mobile rotator cuff tear, single-row repair is a legitimate choice. It takes 23 fewer minutes in the OR, requires fewer anchors, and produces the same UCLA scores and ROM as double-row.
Use this paper to anchor your decision: if a tear is repairable with either technique, the simpler and faster option is not inferior. Reserve double-row for situations where maximizing footprint contact is a priority (e.g., high-demand patients, specific tear geometry where the medial row adds real fixation value).
One important technical note: this trial excluded retracted, immobile tears. The equivalence finding applies only to tears mobile enough to allow double-row repair. Not to all comers.
This Level 1 RCT compared arthroscopic single-row versus double-row suture anchor repair for large and massive rotator cuff tears. Sixty patients were randomized, with 52 completing 2-year follow-up including MR arthrography. The question: does the biomechanical advantage of double-row repair translate into better clinical or imaging outcomes?
The biomechanical case for double-row repair is compelling on paper: it restores more footprint area, reduces gap formation, and improves construct stiffness in cadaveric models. This trial tests whether those lab advantages matter to the patient.
They don't — at least not at 2 years. When you have a large or massive but mobile rotator cuff tear, single-row repair is a legitimate choice. It takes 23 fewer minutes in the OR, requires fewer anchors, and produces the same UCLA scores and ROM as double-row.
Use this paper to anchor your decision: if a tear is repairable with either technique, the simpler and faster option is not inferior. Reserve double-row for situations where maximizing footprint contact is a priority (e.g., high-demand patients, specific tear geometry where the medial row adds real fixation value).
One important technical note: this trial excluded retracted, immobile tears. The equivalence finding applies only to tears mobile enough to allow double-row repair. Not to all comers.