Advances in arthroscopic technique have allowed most rotator cuff tears to be repaired all-arthroscopically. Numerous methods of tendon-bone repair have been reported; however, controversy exists about the superiority of either single-row or double-row fixation constructs with regard to subjective, objective, and structural outcomes.
Biomechanical studies have demonstrated increased mechanical strength, decreased gap formation, improved tendon to bone contact, increased footprint coverage, and watertight isolation of the healing zone interface from the synovial fluid environment in double-row repairs. These favorable biomechanical properties are thought to aid in the healing process while also allowing more aggressive postoperative physical therapy.
However, clinical evidence comparing the efficacy of single-row versus double-row repair has been inconsistent. Whereas some studies report no clinical or anatomic differences between these techniques, others have shown significantly improved subjective, objective, or radiographic outcomes after double-row repair compared with the single-row method. These conflicting results bring into question the cost-effectiveness of double-row repair, given its increased expense and time to perform compared with the single-row method.
Several systematic reviews and meta-analyses have compared the two techniques. However, the inclusion of level II and III studies inhibits the interpretation of these studies. Therefore, the purpose of this study was to perform a systematic review and meta-analysis of all available level I randomized controlled trials comparing single-row with double-row repair to statistically compare their clinical outcomes and imaging-diagnosed re-tear rates. We hypothesized that there would be no statistically significant differences between techniques in this study.