Does the Literature Support Double-Row Suture Anchor Fixation for Arthroscopic Rotator Cuff Repair? A Systematic Review Comparing Double-Row and Single-Row Suture Anchor Configuration
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The treatment of rotator cuff tears continues to evolve with improved instrumentation and suture anchor fixation. Over the past several years, there has been intense interest in optimizing biomechanical fixation constructs to improve tendon-to-bone healing. Specifically, a number of investigators have con- ducted biomechanical studies to determine which suture anchor row configuration may improve initial fixation strength. A number of studies have shown that double-row (DR) suture anchor fixation requires a greater ultimate load to failure and improved restoration of the supraspinatus footprint compared with single-row (SR) suture anchor fixation, whereas other studies have not been able to show a significant difference in in vitro biomechanical strength.
Case series of arthroscopic rotator cuff repair have reported significant improvement in shoulder func- tional outcome and a high rate of patient satisfaction with both SR and DR suture anchor configurations. Several studies in the literature have not shown a difference in postoperative tendon healing between DR and SR repairs. Clinical studies with postoperative imaging modalities have reported that the rate of tendon defects after SR fixation can range from 22% to 94%. Recent case series of arthroscopic rotator cuff repair with DR fixation have shown tendon defects in 11% to 22% of cases. Although there may be an apparent difference in tendon healing, it is difficult to compare across several case series with wide variations in patient demographics, rotator cuff tear characteristics and associated pathology, surgical technique, clinical outcomes, and imaging studies.
To compare SR and DR suture anchor fixation for the arthroscopic repair of rotator cuff tears, we used qualitative systematic review, which uses a defined methodology to collect the most relevant information to answer a specific clinical question. The purpose of this study was to compare the clinical outcome of SR and DR suture anchor fixation in arthroscopic rotator cuff repair with systematic review of the published literature. Our hypothesis is that clinical studies com- paring SR and DR arthroscopic rotator cuff repair do not show a significant difference between subjective and objective outcome measures.
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