Friday, November 8, 2013

single row vs. double row rotator cuff repairs - a meta-analysis

Meta-analysis comparing single-row and double-row repair techniques in the arthroscopic treatment of rotator cuff tears

The authors identified 9 randomized or quasi-randomized clinical trials that reported the outcome of single-row repair and double-row repair techniques. 5 of these were randomized prospective studies. Importantly, nonrandomized comparative clinical studies (level III evidence), reviews, case series, expert opinions, and editorial pieces (level IV and V studies) were excluded. Studies that reported only nonclinical outcome measures or were in vitro and animal studies were also excluded.

They found a statistically significant difference in favor of double-row repair for the overall ASES score, re-tear rate, and internal rotation range of motion. In shoulders with a tear  > 30 mm in the anteroposterior dimension, double-row techniques produced better outcomes than single-row techniques.  However, there were no statistically significant differences in the overall Constant score, UCLA score, external rotation and forward elevation range of motion, or muscle strength. 

Unfortunately, only 5 studies reported retear rates. The rate of failure to achieve anatomic integrity at followup was high: 30 of 126 (23.8%) of the double-row repairs had retears while  53 of 132 (40.2%) of the single-row repairs had retears.  The authors did not report the relationship of retear to clinical outcome.

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