Single Vs Double row repair in rotator cuff tears - A review and analysis of current evidence

Is it enough to utilize a single anchor for repair of rotator cuff tears ≤ 3 * 3 cm²?

BACKGROUND

Biomechanical studies showed that increasing number of anchors could improve the repair strength of the repaired cuff at time zero.

PURPOSE

The aim of this study was to determine if utilizing only a single anchor for a cuff tear repair is sufficient or otherwise to give a similar retear rate and clinical outcome as multiple anchors in a matched group of patients.

STUDY DESIGN

Cohort study; Level of evidence, 3.

METHODS

Retrospective analysis of 346 matched consecutive patients (single anchor group, n = 173; multiple anchors group, n = 173) who had cuff tears ≤ 3*3 cm² (mediolateral * anteroposterior diameters) repaired by a single senior surgeon. Ultrasound was used to evaluate the integrity of repair 6 months post-surgery. Patient and surgeon reported outcomes were used to evaluate the clinical outcome of the method used for repair.

RESULTS

6 months post-surgery; the retear rate for cuff tears ≤ 1*1 cm², tears ≤ 1 cm in mediolateral diameter and > 1 cm in anteroposterior diameter and tears > 1 cm in mediolateral diameter and ≤ 1 cm in anteroposterior diameter was similar in single and multiple anchors groups (4.8%) (3.3%) (P = 1.00), (10.8%) (7.9%) (P = 0.71) and (0%) (0%) respectively. Retear rate for cuff tears > 1*1 cm² was significantly higher in single anchor group (25.4%) compared to multiple anchors groups (10.9%) (P < 0.05). Operative time was significantly lower in single anchor group (14 minutes) compared to multiple anchors group (20 minutes) (P < 0.05) only for cuff tears ≤ 1*1 cm².

CONCLUSION

6-months post-surgery; there was no significant difference in retear rate or clinical outcome between patients with tears ≤ 3*3 cm² (mediolateral * anteroposterior diameters) who had their cuff tears repaired using a single anchor compared to those who had their cuff tears repaired using multiple anchors unless both the mediolateral and anteroposterior diameters of the tear were > 1 cm, for which the utilization of multiple anchors showed a significantly lower retear rate at 6 months post-surgery. Operative time was significantly shorter only when a single anchor was used for repair of tears ≤ 1*1 cm².

A match-pair analysis of single row vs transosseous equivalent double row in massive posterosuperior rotator cuff tears in patients > 70 years old

INTRODUCTION

The aim of this study was to compare the results of single versus double row (TEO) in massive tears of the posterosuperior rotator cuff in patients older than 70 years old.

METHODS

Between October 2019 and July 2022, 46 patients, older than 70 years old, were operated on, in two centers, by one surgeon (FM), in one center, we performed a single-row repair, while in the other a double row, transosseous equivalent. Patients were paired by age and gender. All patients were studied with a preoperative MRI along with preoperative age and gender adjusted constant score. Postoperative patients were evaluated at the end of the FU. Mean time of FU for single row was 3.2 years (2-4.1) and for TOE was 3.5 years (2.4-3). Mean age for SR patients was 71.15 years (70-82) and for TOE was 74.8 years (70-81). We were able to evaluate 20 pairs of patients (15 pairs of females and five pairs of males).

RESULTS

CS differed in both groups of patients. Patients operated on with TOE had a better, but non-significant CS 81.3 (TOE) versus 75.7 (SR) p > 0.05. The patients operated own with TOE showed statistically significant better arm abduction strength than patients operated on with SR (p < 0.05). There was a trend for patients operated on with TOE to have a better ROM and less pain.

DISCUSSION

The results of our work show that patients older than 70 years old, with repairable RCT operated on with a transosseous equivalent, have a trend to have a better CS and a significantly better strength than patients operated on with SR.

Arthroscopic evaluation of the rotator cuff vasculature: inferences into the pathogenesis of cuff tear and re-tear

BACKGROUND

Little is known about alterations of the rotator cuff (RC) macroscopic vasculature associated with medical conditions and/or habits that predispose a person to diseases of the peripheral microcirculation. The high frequency of cuff tear and re-tear in patients with diabetes, hypercholesterolemia, uncontrolled arterial hypertension, or metabolic syndrome may be due to tissue hypovascularity.

METHODS

The macroscopic vasculature of both the articular and bursal sides of the posterosuperior RC was evaluated arthroscopically in 107 patients (mean age, 58.2 years) with no RC tear. Patients were divided into three groups according to medical comorbidities and lifestyle factors (group I, none; group II, smokers and/or drinkers and one comorbidity; and group III, two or more comorbidities). Pulsating vessels originating from both the myotendinous and osteotendinous junctions were assessed as "clearly evident," "poorly evident," or "not evident."

RESULTS

Groups I, II, and III comprised 36, 45, and 26 patients, respectively. Within the myotendinous junction, vessels were visualized in 22 group I patients (61%), 25 group II patients (55%), and 6 group III patients (23%) (P=0.007). Pulsating arterial vessels originating from the osteotendinous junction were seen in 42%, 36%, and 0% of patients, respectively (P<0.001). Within the bursal side of the RC, a dense anastomotic network was visualized (either clearly or poorly) in 94% (34), 80% (36), and 35% (9) of patients, respectively (P<0.001).

CONCLUSIONS

The macroscopic vasculature of the RC is influenced by pre-existing diseases and lifestyle factors, which may impair peripheral microcirculation. Level of evidence: III.

Single-row or Double-row Rotator Cuff Repair

Rotator cuff tears are potentially a career-ending injury for athletes. The surgeon must identify which patients will benefit from surgical repair. The factors to consider are age, type of sport, time since injury, athlete's level, and the patient's expectations. An essential and independent fact determining the surgical treatment is whether the damage is due to overuse or from a traumatic/collision injury. Some sports are more demanding than others resulting in different return-to-participation (RTP) rates. This RTP return rate can present a real challenge and more so by a desire to reach the pre-injury level of play. The incidence of rotator cuff tearing varies from one sport to another. In football players this can be 12% whereas for tennis players this incidence is 4% to 17%. The RTP rate must be considered when making treatment decisions and is influenced by the level of the athlete: for professional athletes, the rate is 61%, and for recreational 73%. When the surgeon and the patient decide on the surgical treatment, the surgeon must consider whether to perform a double-row or a single-row rotator cuff tendon repair. The decision-making and the surgical technique will be addressed.

Arthroscopic rotator cuff repair using a single or double row technique: A meta-analysis of randomized clinical trial

PURPOSE

To compare the double row technique versus the single row technique for arthroscopic rotator cuff repair, in order to assess whether there are clinical differences.

METHODS

Systematic review of randomized clinical trials comparing the clinical results of the double-row technique versus the single-row technique in arthroscopic rotator cuff repair. Demographic, clinical, and surgical variables were analyzed, including functional scores, tendon healing rate, and re-tear rate.

RESULTS

Thirteen randomized clinical trials were selected. 437 patients in the single row group (50.7%) and 424 patients in the double row group (49.3%) were analyzed. No significant differences were found between the two groups in terms of age (P=.84), sex (P=.23) and loss to follow-up (P=.52). Significant differences were found for the better results of the double row technique at the UCLA level (P=.01). No significant differences were found on the Constant-Murley scale (P=.87) or on the ASES scale (P=.56). Similarly, there was a higher healing rate (P=.006) and less risk of rotator cuff re-tears with the double row technique (P=.006).

CONCLUSIONS

In rotator cuff repair, the double row technique was found to be superior to the single row technique in terms of better UCLA score, better tendon healing rate, and lower re-tear rate. No clinically significant differences were found on the Constant-Murley scale or on the ASES scale.

[Single-row versus double-row arthroscopic repair in the treatment of rotator cuff tears. A systematic review.]

Purpose

The purpose of this study is to perform a systematic review of the scientific literature to compare single and double row techniques for rotator cuff tears in terms of functional, pain improvement and structural healing of the tendon.

Methods

In order to carry out the research, a systematic selection of scientific articles has been made by consulting PubMed and The Cochrane Library databases. The articles included in the present study compare the single-row and double-row techniques, with publication date between 2016 and 2021.

Results

Diverse results are observed in the UCLA, SST, Constant and ASES assessment scales and in the range of mobility, therefore, the superiority of one technique in terms of functional results is not established. The double row technique may show superiority in the strength variable, although there is a methodological variability in its measurement. The double-row technique may be related to more intense postoperative pain, while the single-row technique to residual shoulder pain. However, the variables strength and pain show non-homogeneous or coincident data. The superiority of the double row repair in the structural healing of the tendon and a lower re-tear rate than the single row technique is established with statistically significant results, being the most homogeneous and coincident studies.

Long-term follow-up of perianchor cyst formation after rotator cuff repair

Background

Perianchor cyst formation (PCF) can occur after arthroscopic rotator cuff repair with poly-L-lactic acid (PLLA) anchors; however, little is known about PCF after all-suture anchor (ASA) use.

Methods

We reviewed patients who underwent double-row arthroscopic rotator cuff repair from 2012 to 2017 with ASAs implanted in the medial row and PLLA anchors in the lateral row. We evaluated PCF (graded on magnetic resonance imaging) and compared physical examination and functional surveys between patients with PCF (WC) and without PCF (WoC) at long-term follow-up.

Results

Among twenty-two patients (23 shoulders), 93% of PLLA anchors (vs. 79% ASA) displayed a grade 0 PCF, P = .100. No PLLA anchors had a grade 3 or 4 PCF, compared to 11% of ASAs, P = .158. At a mean postoperative follow-up time of 113 weeks, there was no significant difference between WC and WoC cohorts with regard to range of motion, rotator cuff strength, American Shoulder and Elbow Surgeons survey scores, or retear rates. However, the WoC cohort had a significantly higher University of California at Los Angeles shoulder survey score at final follow-up (34.3 WoC vs. 30.9 WC, P = .024).

Conclusion

No difference was found in PCF between ASAs and PLLA anchors. At long-term follow-up, WoC patients had significantly improved functional outcome scores, based on the University of California at Los Angeles survey, but equivalent range of motion and rotator cuff strength examinations compared with WC patients.

Outcomes of and factors influencing the arthroscopic treatment of rotator cuff injury with the patient in the lateral-lying and beach chair positions

To compare the postoperative effects of arthroscopy for rotator cuff injury with patients in the lateral-lying position (LLP) and beach chair position (BCP), and to identify factors influencing these effects.Data from patients with rotator cuff injuries who underwent shoulder arthroscopy in the LLP (n = 115, 53.24%) or BCP (n = 101, 46.76%) between January 2013 and 2016 and were followed for >3 years were analyzed. The American Shoulder and Elbow Surgeons shoulder score, University of California at Los Angeles shoulder score (UCLASS), and visual analog scale (VAS) score were used to evaluate patients' shoulder function and pain preoperatively and at the last follow-up examination. The abduction and lateral rotation angles were measured. The influences of patient characteristics were compared between the LLP and BCP subgroups defined by UCLASSs (excellent, good, acceptable, poor).Postoperative injury characteristics, UCLASSs, and VAS scores were better in the LLP group than in the BCP group (all P < .05). Among patients with good UCLASSs, preoperative pain duration was longer in the LLP group than in the BCP group (P < .05); among those with acceptable UCLASSs, this duration was longer in the BCP group than in the LLP group (P < .05). The preoperative flexion angle differed between groups (P < .05). Among patients with excellent and good UCLASSs, the postoperative external rotation angle was greater in the LLP group than in the BCP group (P < .05). The LLP group contained more excellent UCLASSs than did the BCP group (P < .05). It also contained more small, medium, and large tear cases than did the BCP group (all P < .05).The effect of arthroscopy for rotator cuff injury was better when the operation was performed with the patient in the LLP. Either position is suitable for the arthroscopic treatment of partial rotator cuff tears. The LLP is more suitable in cases of small and medium-sized tears and those with large preoperative lateral rotation angles. The BCP should be used for patients with large preoperative flexion angles.