Controversial Issue in Shoulder Surgery
Surgeons are grappling with the question of whether a single row of sutures to repair a torn rotator cuff is enough or are the results better with a double row? Some studies have shown that a double row of sutures provides greater stability and biomechanical strength. But similar studies to prove the clinical value (e.g., fewer complications, better shoulder function) are lacking.
To help solve the debate, surgeons at Boston University School of Medicine conducted a systematic review. This means they searched all previously published articles on this topic to see if there was any consensus or agreement from the studies done so far. They found seven suitable studies to include in their analysis.
Although they found a trend toward more failures in the single-row group, it wasn't significant enough to say single-row sutures is an inferior repair method compared with double-row sutures. At this point, you may be wondering what's the difference in these two surgical techniques?
Both single-row and double-row suture technique can be done arthroscopically without a wide open incision. Arthroscopic surgery is less invasive and involves less cutting into the soft tissues such as muscles and tendons. The benefit in the end is less scarring, less pain, fewer injuries to important soft tissues such as muscles.
Double-row sutures brings more of the tendon in contact with the bone. The hope is that more fibers will be recruited in the healing process. This might result in a more stable repair. Double-row sutures also means less stress and force are applied to each individual suture. There is also the potential for less gapping in the soft tissues where they should be smooth and closely reattached to the bone.
But as this systemic review showed, the retear rate, number of complications, and functional outcomes were not statistically different between the two suture repair techniques. There was a trend toward a higher retear rate among the single-row group. But again, this difference did not reach statistical significance. The mechanically superior double-row fixation simply does not improve the final results.
The authors concluded that further study of this topic is needed. They suggested that perhaps rotator cuff tear site, size, and quality make a difference and should be included in the analysis.
Alexander M. DeHaan, MD, et al. Does Double-Row Rotator Cuff Repair Improve Functional Outcome of Patients Compared with Single-Row Technique? A Systematic Review. In The American Journal of Sports Medicine. May 2012. Vol. 40. No. 5. Pp. 1176-1185.