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. 2016 Oct 3;4(10):2325967116667398.
doi: 10.1177/2325967116667398. eCollection 2016 Oct.

Functional Outcomes After Double-Row Versus Single-Row Rotator Cuff Repair: A Prospective Randomized Trial

Stephen J Nicholas  1 , Steven J Lee  1 , Michael J Mullaney  1 , Timothy F Tyler  1 , Takumi Fukunaga  1 , Christopher D Johnson  1 , Malachy P McHugh  1
Affiliations

Functional Outcomes After Double-Row Versus Single-Row Rotator Cuff Repair: A Prospective Randomized Trial

Stephen J Nicholas et al. Orthop J Sports Med. .

Abstract

Background: The functional benefits of double-row (DR) versus single-row (SR) rotator cuff repair are not clearly established.

Purpose: To examine the effect of DR versus SR rotator cuff repair on functional outcomes and strength recovery in patients with full-thickness tears.

Study design: Randomized controlled trial; Level of evidence, 2.

Methods: Forty-nine patients were randomized to DR or SR repairs; 36 patients (13 women, 23 men; mean age, 62 ± 7 years; 20 SR, 16 DR) were assessed at a mean 2.2 ± 1.6 years after surgery (range, 1-7 years; tear size: 17 medium, 13 large, 9 massive). The following data were recorded prior to surgery and at follow-up: Penn shoulder score, American Shoulder and Elbow Surgeons (ASES), and Simple Shoulder Test (SST) results; range of motion (ROM) for shoulder flexion, external rotation (ER) at 0° and 90° of abduction, and internal rotation (IR) at 90° of abduction; and shoulder strength (Lafayette manual muscle tester) in empty- and full-can tests, abduction, and ER at 0° of abduction. Treatment (SR vs DR) × time (pre- vs postoperative) mixed-model analysis of variance was used to assess the effect of rotator cuff repair.

Results: Rotator cuff repair markedly improved Penn, ASES, and SST scores (P < .001), with similar improvement between SR and DR repairs (treatment × time, P = .38-.10) and excellent scores at follow-up (DR vs SR: Penn, 91 ± 11 vs 92 ± 11 [P = .73]; ASES, 87 ± 12 vs 92 ± 12 [P = .21]; SST, 11.4 ± 1.0 vs 11.3 ± 1.0 [P = .76]). Patients with DR repairs lost ER ROM at 0° of abduction (preoperative to final follow-up, 7° ± 10° loss [P = .013]). ER ROM did not significantly change with SR repair (5° ± 14° gain, P = .16; treatment by time, P = .008). This effect was not apparent for ER ROM at 90° of abduction (treatment × time, P = .26). IR ROM improved from preoperative to final follow-up (P < .01; SR, 17° ± 27°; DR, 7° ± 21°; treatment × time, P = .23). Rotator cuff repair markedly improved strength in empty-can (54%), full-can (66%), abduction (47%), and ER (54%) strength (all P < .001), with no difference between SR and DR repairs (P = .23-.75). All clinical tests with the exception of the lift-off test were normalized at follow-up (P < .05).

Conclusion: Outcomes were not different between SR or DR repair, with generally excellent outcomes for both groups. Rotator cuff repair and subsequent rehabilitation markedly improved shoulder strength.

Keywords: empty-can test; full-thickness tear; handheld dynamometer; shoulder strength.

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Conflict of interest statement

One or more of the authors has declared the following potential conflict of interest or source of funding: S.J.N. receives royalties from Arthrex Inc. S.J.L. is a paid consultant for Arthrex Inc.

Figures

Figure 1.
Figure 1.
CONSORT (Consolidated Standards of Reporting Trials) flow diagram. DR, double-row; SR, single-row.
Figure 2.
Figure 2.
Functional outcome scores prior to and after surgery. (A) ASES scores: treatment × time, P = .38; time effect, P < .001. (B) Penn scores: treatment × time, P = .10; time effect, P < .001. (C) SST scores: treatment × time, P = .32; time effect, P < .001. ASES, American Shoulder and Elbow Surgeons; SST, simple shoulder test.
Figure 3.
Figure 3.
Clinical outcome scores prior to and after surgery. (A) Empty-can strength: effect of time, P < .001; treatment × time, P = .69. (B) Full-can strength: effect of time, P < .001; treatment × time, P = .23. (C) Abduction strength: effect of time, P < .001; treatment × time, P = .55. (D) External rotation strength: effect of time, P < .001; treatment × time, P = .75.
See this image and copyright information in PMC

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