Wednesday, July 18, 2012

A Multicenter Randomized Controlled Trial Comparing Single-Row with Double-Row Fixation in Arthroscopic Rotator Cuff Repair - JBJS



The JBJS has just published "A Multicenter Randomized Controlled Trial Comparing Single-Row with Double-Row Fixation in Arthroscopic Rotator Cuff Repair"

This most recent article is a well done Level I randomized multicenter trial comparing two methods of arthroscopic fixation. The analysis showed no significant difference between the results of the two methods.  "No significant differences between the single-row and double-row groups were found in the WORC, ASES, or Constant scores or strength at any time point".

Perhaps of greater interest is that the failure rate was substantial - while 55 of the repairs were intact, 21 were retorn by imaging at the time of followup. Bigger tears at the index surgery had a higher retear rate. These results are consistent with others showing that surgeons' attempts to re-establish rotator cuff integrity fail not infrequently in spite of the repair method.. See our posts from October 2, 2011, April 1, 2012,  April 19, 2012, and June 4, 2012 as well as the classic article by Harryman.

Of even greater interest is that they join the other articles that demonstrated no significant difference in their primary outcome measure, the Western Ontario Rotator Cuff Index, between tears that had retorn vs those that did not. This discordance has been noted before in this blog and here.

So again we see that we still have a lot to learn regarding the factors that determine the quality of the result of treatment of rotator cuff tears. For a humbling assessment of what is known, check out this summary.


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