These authors sought to analyze the literature comparing single row (SR) and double-row (DR) rotator cuff repairs with particular attention to the specific technique types that were compared.
Primary studies from 8 high-quality metaanalyses published prior to 2014, and any Level-III or higher studies published from 2014 to 2019, were included.
Manuscripts were classified on the basis of the specific type of simple or complex SR or DR repair performed.
Of the 22 studies, only 3 (14%) of the studies compared a biomechanically superior complex SR technique and a DR repair.The remaining 19 (86%) of the studies utilized biomechanically inferior, simple SR techniques in their comparisons.
Among the articles in which simple SR repair was compared with classic DR, all 12 studies assessed clinical outcomes. Nine (75%) of the 12 found no clinical difference between these repair techniques.
Six studies compared simple SR and transosseous-equivalent DR and presented conclusions regarding clinical outcomes. Five (83%) of the 6 found no clinical difference between the techniques.
Of the studies comparing simple SR with any type of DR, 14 (78%) of 18 studies concluded there was no difference in clinical results.
Three studies compared more complex SR techniques with transosseous equivalent DR; essentially no significant differences in clinical outcomes were reported between the techniques
Comment: This article reinforces the view that in spite of a massive literature on cuff repair techniques, it is unclear that the clinical outcomes are improving. Readers may be interested in the article Published Evidence on Factors Associated With Repair Integrity and Clinical Outcome
Three studies compared more complex SR techniques with transosseous equivalent DR; essentially no significant differences in clinical outcomes were reported between the techniques
Comment: This article reinforces the view that in spite of a massive literature on cuff repair techniques, it is unclear that the clinical outcomes are improving. Readers may be interested in the article Published Evidence on Factors Associated With Repair Integrity and Clinical Outcome
In this report, 108 of these articles, reporting on over 8011 shoulders, met the inclusion criteria of reporting quantitative data on both imaging and clinical outcomes after rotator cuff repair.
The article found that while the number of relevant articles published per year increased dramatically over the period of the study, the clinical and anatomic results did not show improvement over this period. The weighted mean retear rate was 26.6% at a mean of 23.7 months after surgery. Retears were associated with more fatty infiltration, larger tear size, advanced age, and double-row repairs.
Clinical improvement averaged 72% of the maximum possible improvement. Patient-reported outcomes were generally improved whether or not the repair restored the integrity of the rotator cuff.
The authors concluded that in spite of a dramatic increase in the number of publications per year, there is little evidence that the results of rotator cuff repair are improving. The information needed to guide the management of this commonly treated and costly condition is seriously deficient.
Interestingly, while the number of articles written about cuff repair has risen exponentially, the outcomes in terms of cuff integrity, clinical scores and percent of possible improvement have not improved over the last several decades.
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