This critical analysis review compares single-row versus double-row arthroscopic repair for full-thickness posterosuperior rotator cuff tears. It synthesizes biomechanical data, Level-I clinical trials, and a meta-analysis to guide construct selection. The authors also weigh newer transosseous-equivalent and knotless techniques.
When choosing a repair construct, separate biomechanics from clinical outcomes in your reasoning. Double-row and transosseous-equivalent repairs win decisively on footprint contact, compression, load to failure, and gap resistance, and they lower imaging-proven retear rates.
The catch: two-year outcome scores are equivalent between techniques. The authors argue this reflects underpowered trials (needing ~170 shoulders per arm) and follow-up too short to capture asymptomatic retears becoming symptomatic.
A practical mental model: the bigger the tear, the more double-row matters. Benefits emerge in tears >3 cm, and at 5 years double-row was 4.9x more likely to give a good or excellent result in large-to-massive tears.
Know the grade of recommendation table for boards: grade A for 3-5 cm tears, grade B for <3 cm, and insufficient evidence (grade I) for massive tears where tendon mobility may force a single-row repair.
This critical analysis review compares single-row versus double-row arthroscopic repair for full-thickness posterosuperior rotator cuff tears. It synthesizes biomechanical data, Level-I clinical trials, and a meta-analysis to guide construct selection. The authors also weigh newer transosseous-equivalent and knotless techniques.
When choosing a repair construct, separate biomechanics from clinical outcomes in your reasoning. Double-row and transosseous-equivalent repairs win decisively on footprint contact, compression, load to failure, and gap resistance, and they lower imaging-proven retear rates.
The catch: two-year outcome scores are equivalent between techniques. The authors argue this reflects underpowered trials (needing ~170 shoulders per arm) and follow-up too short to capture asymptomatic retears becoming symptomatic.
A practical mental model: the bigger the tear, the more double-row matters. Benefits emerge in tears >3 cm, and at 5 years double-row was 4.9x more likely to give a good or excellent result in large-to-massive tears.
Know the grade of recommendation table for boards: grade A for 3-5 cm tears, grade B for <3 cm, and insufficient evidence (grade I) for massive tears where tendon mobility may force a single-row repair.