Comparison of Arthroscopic Single-row and Double-row Repair for Rotator Cuff Injuries With Different Tear Sizes: A Systematic Review and Meta-analysis

Abstract

Background: There is no clinical gold standard for the indications for single-row (SR) versus double-row (DR) repair according to small, large, or massive rotator cuff tear size.

Purpose: To conduct a meta-analysis to compare the clinical outcomes and retear rates after arthroscopic SR and DR repair for rotator cuff injuries with different tear sizes.

Study design: Systematic review; Level of evidence, 3.

Methods: On the basis of PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) criteria, the PubMed, Embase, Cochrane Library databases, Web of Science, China National Knowledge Infrastructure, and China BioMedical Literature database were searched for relevant studies published before November 1, 2021, using the following search terms: "Rotator Cuff Injuries," "Rotator Cuff Tears," "Arthroscopy," "Arthroscopic Surgery," "single-row," and "double-row"; a total of 489 articles were retrieved. Quality evaluation was conducted for all the studies that met the inclusion criteria. This study evaluated the Constant-Murley score, American Shoulder and Elbow Surgeons (ASES) score, University of California, Los Angeles (UCLA) score, and range of motion (ROM) as well as retear rate. A fixed-effects or random-effects model was adopted to calculate the results and assess risk.

Results: A total of 10 clinical studies were included, with 404 cases of DR and 387 cases of SR. Regarding overall results, DR had better forward elevation ROM (mean difference [MD] = -4.03° [95% CI, -6.00° to -2.06°]; P < .0001; I ² = 46%) and a lower retear rate (MD = 2.39 [95% CI, 1.40 to 4.08]; P = .001; I ² = 0%) compared with SR repair. With regard to small tears (<3 cm), there was no noticeable difference on any of the 3 outcome scores between SR and DR. For large rotator cuff tears (≥3 cm), DR repair showed significantly better ASES scores (MD = -3.09 [95% CI, -6.19 to 0.02]; P = .05; I ² = 73%) and UCLA scores (MD = -1.47 [95% CI, -2.21 to -0.72]; P = .0001; I ² = 31%) compared with SR repair.

Conclusion: Our meta-analysis revealed that DR had better UCLA scores, ASES scores, and ROM in forward elevation and lower retear rates. In rotator cuff tears <3 cm, there were no statistical differences in clinical outcome between SR and DR.

Keywords: arthroscopic rotator cuff repair; clinical outcomes; double-row; fixation; rotator cuff injuries; single-row.

Figure 1.

PRISMA flowchart of data extraction. PRISMA, Preferred Reporting Items for Systematic Reviews and Meta-Analyses

Figure 2.

Qualitative assessment of the RCTs included in the review. (A) Risk of bias summary according to study. (B) Graph showing overall risk of bias percentages. RCT, randomized controlled trial.

Figure 3.

Forest plots for the comparison of ASES score (A) overall, (B) for small tears, and (C) for large tears. ASES, American Shoulder and Elbow Surgeons; IV, inverse variance; (L), large tear; (s), small tear.

Figure 4.

Forest plots for the comparison of UCLA score (A) overall, (B) for small tears, and (C) for large tears. IV, inverse variance; (L), large tear; (s), small tear; UCLA, University of California, Los Angeles.

Figure 5.

Forest plots for the comparison of CMS (A) overall, (B) for small tears, and (C) for large tears. CMS, Constant-Murley score; IV, inverse variance; (L), large tear; (s), small tear.

Figure 6.

Forest plots for the comparisons of (A) forward elevation ROM and (B) external rotation ROM. IV, inverse variance; (L), large tear; ROM, range of motion; (s), small tear.

Figure 7.

Forest plots for the comparison of retear rates (A) overall, (B) for small tears, and (C) for large tears. (L), large tear; M-H, Mantel-Haenszel; OR, odds ratio; (s), small tear.