Double-row vs single-row rotator cuff repair: A review of the biomechanical evidence

Hypothesis: A review of the current literature will show a difference between the biomechanical properties of double-row and single-row rotator cuff repairs. Background: Rotator cuff tears commonly necessitate surgical repair; however, the optimal technique for repair continues to be investigated. Recently, double-row repairs have been considered an alternative to single-row repair, allowing a greater coverage area for healing and a possibly stronger repair. Materials and Methods: We reviewed the literature of all biomechanical studies comparing double-row vs single-row repair techniques. Inclusion criteria included studies using cadaveric, animal, or human models that directly compared double-row vs single-row repair techniques, written in the English language, and published in peer reviewed journals. Identified articles were reviewed to provide a comprehensive conclusion of the biomechanical strength and integrity of the repair techniques. Results: Fifteen studies were identified and reviewed. Nine studies showed a statistically significant advantage to a double-row repair with regards to biomechanical strength, failure, and gap formation. Three studies produced results that did not show any statistical advantage. Five studies that directly compared footprint reconstruction all demonstrated that the double-row repair was superior to a single-row repair in restoring anatomy. Conclusions: The current literature reveals that the biomechanical properties of a double-row rotator cuff repair are superior to a single-row repair. Level of evidence: Basic Science Study, SRH = Single vs. Double Row RCR.