Arthroscopic single-row versus double-row repair rotator cuff tear: a meta-analysis of randomized controlled trials at 2-years minimum follow-up

Abstract Objective: The purpose of this study was to perform a meta-analysis of all available randomized controlled trials at 2-years minimum follow-up, to compare the clinical outcomes and radiological re-tear rates between single-row (SR) and double-row (DR) fixation. Methods: PubMed, EMBASE, and Cochrane databases search were performed for meta-analysis. Randomized controlled trials at 2-years minimum follow-up which comparing clinical outcomes and radiological re-tear rates between single-row and double-row fixation for rotator cuff repair. Clinical outcomes included the American Shoulder and Elbow Surgeons score (ASES), University of California–Los Angeles score (UCLA), and Constant score; the radiological re-tear rate was assessed by Magnetic Resonance Imaging (MRI), Magnetic Resonance Angiography (MRA)or Ultrasonic (US). Two trained authors extracted data from all included articles, and if there are different opinions, the final decision would be made by the senior professor after reviewed the article.Results: Six Level Ⅰ articles and two Level Ⅱ articles were included. In clinical outcomes, ASES, Constant score and forward flexion range of motion (ROM) showed no statistically significant difference between DR fixation and SR fixation technique at 2-years follow-up (P=0.61, P=0.19, P=0.17). UCLA score and internal rotation ROM were significantly better in DR group (P=0.005, P=0.001). DR repair showed less overall re-tear and partial re-tear rate and more intact rotator cuff than SR repair in radiological outcomes after 2-years follow-up (P=0.0002, P=0.02, P=0.0003).Conclusion: The best current available evidence suggest that DR fixation technique have similar outcomes in ASES, Constant score and forward flexion ROM with SR fixation. However, DR group show higher UCLA score, greater internal rotation ROM and better radiological outcomes (include less overall re-tear and partial re-tear rate and more intact rotator cuff) than SR group after 2-years follow-up.Level of Evidence: Level Ⅱ, meta-analysis