ICJR DEBATES: Single-Row vs. Double-Row Repair of Rotator Cuff Tears

    Although single-row repair is the traditional surgical method of treating rotator cuff tears, double-row repair is becoming increasingly popular. Is one better than the other?

    Rotator cuff tears are one of the most common types of shoulder damage, often affecting the rotator cuff tendons. These tears can impair lifting and rotation of the arm. Surgical treatment involves implantation of a single medial or lateral row of suture anchors or a double row of suture anchors (medial and lateral).

    At ICJR’s Shoulder Course in Las Vegas, James Esch, MD, from the Orthopaedic Specialists of North County in Oceanside, California, said that single-row repair offers the advantages of lower cost and better healing than double-row repair. Single-row repair is also less-often associated with overtensioning, which can cause failure of the muscle-tendon junction, Dr. Esch added. He asserted that the effectiveness of cuff repair depends on the number of sutures, not on the number of suture anchors.

    Evan Flatow, MD, from Mount Sinai Medical Center in New York, New York, has a different view. He countered that double-row repair provides better biomechanical properties, including improved strength, less gaping under load, improved tendon-bone contact area and pressure, and a better “seal.”

    Both speakers agreed that randomized, prospective clinical trials have found no significant difference between the two methods for functional outcomes, such as pain and well-being.

    However, studies show a trend towards better healing with double-row repair, Dr. Flatow said. He pointed out that although the difference was not significant, these studies looked at healing relatively soon after surgery. Longer follow-up times may reveal a significant advantage, Dr. Flatow said.

    Both types of repair are susceptible to retears. Dr. Esch maintained that double-row repair is more likely to fail at the muscle-tendon and bone-tendon junctions, while Dr. Flatow referred to a trend towards higher retear rates with single-row repair.

    Dr Esch concluded that because double-row repair has no demonstrated advantage over single-row repair, single-row is better, given its lower cost. Dr. Flatow summarized his side of the debate by saying that double-row repair is now faster and cheaper than before, its disadvantages are being reduced, and it provides a firmer seal of the interface during healing.

    Click the images below to watch their presentations.

    Dr. James Esch

    Dr. Evan Flatow