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Arthroscopic Rotator Cuff Repair (Double Row Repair): Current Evidence

BACKGROUND: Surgical techniques for rotator cuff tears have improved from single row repair (SR) to double row repair (DR) including transosseous equivalent repair as new surgical devices or suture anchors were developed. Many biomechanical evidence favors DR with respect to footprint contact area and pressure and compression for cuff tendons. Some surgeons reported better clinical outcomes of DR compared to SR, whereas some described no difference of clinical outcomes between SR and DR. The purpose of this article was to review the current evidence regarding outcomes of DR comparing to SR and clarify whether better clinical or radiological outcomes can be obtained by performing DR. METHODS: We conducted a systematic review of clinical studies published for last 5 years which compared SR to DR. A systematic review of the literature was performed to identify all publications in the English literature. The databases MEDLINE and Google Scholar were searched. Also, we reviewed the latest systematic review and meta-analysis published between 2012 and 2018. RESULTS: Four clinical articles with evidence Levels I or II published in last 5 years were identified. Two of them documented superiority of DR over SR. Four systematic review and meta-analysis published between 2012 and 2018 were identified. Among them, two showed that DR provides better clinical outcomes and a lower re-tear rate compared with SR but its superiority is seen in the limited situation (only large tears or UCLA score). CONCLUSION: Although some reports with higher evidence Levels showed DR provides better clinical outcomes, it may be too early to conclude which repair technique is better because of lack of enough evidence.