Arthroscopy - 2026-08-24 - Journal Article; Review
Double-Row Repair Improves Outcomes for Large Rotator Cuff Tears but Offers No Advantage for Small-to-Medium Tears: A Systematic Review and Meta-analysis of Randomized Controlled Trials.
Seok HG, Park JJ, Park SG
Topics
Key Takeaway
Double-row repair reduces retear risk by nearly half compared to single-row (OR 1.88) for tears ≥30 mm, but provides no functional or structural advantage for tears <30 mm.
Summary Depth
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Summary
This meta-analysis of 18 RCTs compared single-row versus double-row arthroscopic rotator cuff repair across retear rates, functional scores, ROM, and operative time, with prespecified subgroup analysis by tear size (threshold 30 mm). Overall, double-row repair reduced retear rates (OR 1.88; 95% CI 1.33–2.66) and improved UCLA scores and forward flexion, but increased operative time. Subgroup analysis showed these advantages were confined to tears ≥30 mm; for tears <30 mm, no significant difference existed in any outcome.
Key Limitation
The 30 mm size threshold for subgroup analysis was not uniformly defined or measured across included RCTs, introducing misclassification bias that could attenuate or exaggerate the observed tear-size interaction.
Original Abstract
PURPOSE
To systematically review the extant literature for randomized controlled trials comparing the primary outcome of retear rates and secondary outcomes, including functional scores, range of motion, and operative times, between single-row (SR) and double-row (DR) arthroscopic rotator cuff repairs.
METHODS
PubMed, Cochrane Library, Embase, and Web of Science were searched for studies comparing the clinical outcomes of patients who underwent arthroscopic rotator cuff repair with the SR or DR technique. Eighteen randomized controlled trials were identified. The retear rates, functional scores, range of motion, and operative times were analyzed. A subgroup analysis was conducted based on the tear size (30 mm).
RESULTS
Eighteen studies involving 1308 patients were included. The DR group had better University of California Los Angeles score (standardized mean difference [SMD] = -0.28; 95% confidence intervals (CI), -0.44, -0.12; I2 = 7%), enhanced forward flexion (standardized mean difference = -0.38; 95% CI, -0.58, -0.19; I2 = 26%), and a lower overall (OR = 1.88; 95% CI, 1.33, 2.66; I2 = 27%) and partial-thickness (OR = 2.81; 95% CI, 1.50, 5.24; I2 = 3%) retear rate than the SR group. Conversely, the SR group exhibited a reduced operation time (standardized mean difference = -0.74; 95% CI, -1.04, -0.43; I 2 = 40%). For tears >30 mm, DR repair was superior to SR repair in American Shoulder and Elbow Surgeons score, University of California Los Angeles score, and retear rates. However, for tears <30 mm, no significant between-group difference was noted.
CONCLUSIONS
The DR repair exhibited superiority in retear rates, University of California Los Angeles scores, and forward flexion, despite longer operative times. For tears ≥30 mm, the use of DR repair consistently yielded superior functional and radiological outcomes. However, for tears <30 mm, studies have shown that SR and DR repairs have comparable clinical results and retear rates. This suggests that DR repair is more recommended than SR repair for large tears, but the more efficient SR repair is a suitable option for tears ranging from small to medium in size.
LEVEL OF EVIDENCE
Level II, meta-analysis of Level I and II studies.