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Results of arthroscopic single-row cuff repair comparable to double-row method

Investigators said treatment differences among 60 randomized patients were not significant.

Issue: September 2008

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Classic rotator cuff tears attained similar short-term clinical outcomes with both single- and double-row arthroscopic suture anchor technique, according to a randomized multinational study.

In presenting the study’s findings at the American Orthopaedic Society for Sports Medicine (AOSSM) 2008 Annual Meeting, Francesco Franceschi, MD, said, “We can conclude that there are no advantages in our hands in using a double-row suture anchor technique to restore the anatomical footprint.”

Franceschi and colleagues were presented with the AOSSM 2008 Hughston Award for the study. The award is given annually to the sports medicine paper judged to be the best by an international jury of sports medicine specialists.

Randomized study

The 60-patient study was conducted as a collaboration between Campus Biomedico University in Rome and Keele University in Stoke-on-Kent, England. It was published last year in the American Journal of Sports Medicine.

Patients enrolled in the study were randomized into two groups of 30 patients and had their rotator cuff tears treated arthroscopically with either a single- or double-row suture anchor technique.

For inclusion in the study, patients could not have any shoulder instability or fractures.

They were followed up for a minimum of 2 years.

MRI studies

Patients underwent preoperative assessment through radiographs and MRI scans. At final follow-up they also had magnetic resonance arthrography with gadolinium contrast injection all performed by the same musculoskeletal radiologist. Radiologists diagnosed any rotator cuff tears that persisted after treatment by comparing preoperative and postoperative MRIs.

Four patients from each group did not return for their final visit, leaving 26 patients in each group or 52 patients overall in the final analysis.

Investigators based final results on range of motion outcomes, as well as the patients’ pre-and postoperative modified University of California-Los Angeles (UCLA) shoulder score, which took into account pain, function, range of motion and strength.

Single-row sufficient

“If you compare the two groups, you will find no statistical difference based on UCLA and range of motion [outcomes],” Franceschi noted.

At a mean follow-up of 22.5 months, 14 patients in the single-row group had intact tendons, 10 patients had partial thickness tears and two patients had full-thickness defects. In the double-row group, there were 18 intact tendons, seven partial tears and one patient still had a full-thickness tear.

Lately, too much emphasis has been placed on the double-row technique, Franceschi said. Good clinical results that are anatomically successful do not require such an involved and complicated technique, he explained.

“The mechanical advantages evidenced in cadaveric studies do not translate into superior clinical performance when compared with a more traditional, technically less demanding and more economical technique of single-row suture anchor repair,” he said.

For more information:

• Francesco Franceschi, MD, can be reached in the Department of Orthopaedic and Trauma Surgery, Campus Biomedico University, via Longoni, 83 Rome, Italy; 39-6-22541-1; e-mail: osa14@keele.ac.uk. He has no direct financial interest in any products or companies mentioned in this article.

References:

• Franceschi F, Ruzzini L, Longo UG, Martina FM, Zobel BB, Maffulli M, Denaro V. Equivalent clinical results of arthroscopic single-row and double-row suture anchor repair for rotator cuff tears: A randomized controlled trial. Am J Sports Med 2007;35:1254-1260.
• Franceschi F, Ruzzini L, Longo UG, et al. Hughston Award Presentation: Equivalent clinical results of arthroscopic single-row and double-row suture anchor repair for rotator cuff tears: A randomized controlled trial. Presented at the American Orthopaedic Society for Sports Medicine 2008 Annual Meeting. July 10-13, 2008. Orlando, Fla.