Clinical and structural outcomes after arthroscopic single-row versus double-row rotator cuff repair: a systematic review and meta-analysis of level I randomized clinical trials

Authors:

Peter J Millett, Ryan J Warth, Grant J Dornan, Jared T Lee, Ulrich J Spiegl

Abstract:

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.

For the complete study: Clinical and structural outcomes after arthroscopic single-row versus double-row rotator cuff repair: a systematic review and meta-analysis of level I randomized clinical trials

Peter Millett, MD

Average rating:

39 reviews

Alexandra Thompson

Mar 23, 2024

by Alexandra Thompson on Peter Millett, MD

110%

Dr. Millett and his team did a SLAP tear repair and bicep tenodesis on my left shoulder. I use my arms as an artist, and love to swim in the ocean, surf, paddle, and telemark ski. So regaining full use of my shoulder and keeping my bicep attached was very important to me. Now, over two years later, my shoulder has the equivalent range of motion as my other arm and as before the injury, and no pain. After the first three months it felt so good and was so strong that - to my horror - I completely forgot my six-month follow-up.

Not only did Dr. Millett and his team make my arm as good as new, but having had the experience of such kindness and expertise throughout the process of surgery and recovery is like an added shoulder superpower.

Thank you Rita, Brooke, Jason, Sarah, Camille, Olivia, Dr. Millett and everyone! And see you soon when my husband comes in for his knee...

Jeff Chandler

Jan 31, 2022

by Jeff Chandler on Peter Millett, MD

Flawless procedure, Easy recovery

Dr. Millet's repaired my knee and tibia, following a botched operation by a different surgeon. That procedure was virtually pain free and I was weight bearing within a few days. That was 18 years ago and the knee is still strong. A few years after the knee incident, Dr Millet repaired my shoulder. My insurance company approved me for 3 months of disability following that surgery. I was off pain medication in 2 days and had 90% range of motion within a week. I withdrew my disability claim and returned to work within two weeks of surgery. I’m not a famous athlete—just a regular guy. Nonetheless, I was treated like an NFL at the Steadman clinic. Most notable was the time for recovery. Other surgeons perform their hour-long task in the OR and don’t involve themselves in the other functions. Peter and his team manages the entire process from diagnosis, anesthesia, nursing care, and therapy. He takes a holistic approach to patient care and doesn’t skip any steps.

Jenn West

Jul 2, 2021

by Jenn West on Peter Millett, MD

Saved My Life

I went to Dr. Millett after 7 knee surgeries (6 on my right and 1 on my left) and had seen 11 different surgeons who all refused to remove femur metal from my right leg. I am highly allergic to metal and the chronic pain was leaving me bedridden for 3.5wks out of a month. He personally wrote me back on my inquiry, listened to my concerns, scheduled my surgery within a week (due to insurance issues) and personally followed up with my recovery. The level of patient care from Dr. Millett and his ENTIRE team is above any care I have ever received in my 20 years of dealing with orthopedic surgeons. There are not enough words to describe the level of care, dedication and professionalism you receive from Dr. Millett and his staff.
My only disappointment is that I did not find him sooner!!!

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Clinical and structural outcomes after arthroscopic single-row versus double-row rotator cuff repair: a systematic review and meta-analysis of level I randomized clinical trials

Authors:

Abstract:

About the Author: Peter Millett, MD