This Level I RCT compares single-row versus double-row arthroscopic rotator cuff repair in 80 patients with full-thickness tears. Outcomes were measured with DASH, Work-DASH, normalized Constant score, and dynamometer strength at 2 years. The question: does the biomechanical advantage of double-row fixation produce a real clinical benefit?
The core tension here is biomechanics versus clinical reality. Cadaveric studies clearly show double-row fixation restores a larger footprint with stronger fixation, so intuition says it should heal better. This RCT tested that intuition and found no clinical payoff at 2 years across DASH, Constant score, and strength.
The key mental model: a stronger construct on the bench does not guarantee a better patient. The authors even raise a counter-mechanism, that a stiffer double-row construct may compromise blood supply to an already diseased tendon.
A major caveat weights this evidence: there was no postoperative imaging, so a difference in structural healing could exist without showing up in these short-term functional scores. Other studies with imaging found better tendon integrity with double-row, especially in large tears.
The practical takeaway for a resident: for smaller tears, single-row is a defensible, faster, cheaper choice. The double-row advantage, if real, is most likely to appear in large and massive tears, where this study was underpowered to detect it.
This Level I RCT compares single-row versus double-row arthroscopic rotator cuff repair in 80 patients with full-thickness tears. Outcomes were measured with DASH, Work-DASH, normalized Constant score, and dynamometer strength at 2 years. The question: does the biomechanical advantage of double-row fixation produce a real clinical benefit?
The core tension here is biomechanics versus clinical reality. Cadaveric studies clearly show double-row fixation restores a larger footprint with stronger fixation, so intuition says it should heal better. This RCT tested that intuition and found no clinical payoff at 2 years across DASH, Constant score, and strength.
The key mental model: a stronger construct on the bench does not guarantee a better patient. The authors even raise a counter-mechanism, that a stiffer double-row construct may compromise blood supply to an already diseased tendon.
A major caveat weights this evidence: there was no postoperative imaging, so a difference in structural healing could exist without showing up in these short-term functional scores. Other studies with imaging found better tendon integrity with double-row, especially in large tears.
The practical takeaway for a resident: for smaller tears, single-row is a defensible, faster, cheaper choice. The double-row advantage, if real, is most likely to appear in large and massive tears, where this study was underpowered to detect it.