Arthroscopy The Journal of Arthroscopic and Related Surgery · IF 4.4 · August 24, 2026 · LoE I
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
Hyun-Gyu Seok, Jeong-Jin Park, Sam‐Guk Park — Armed Forces Capital Hospital
This meta-analysis pooled 18 randomized trials (1,308 patients) comparing single-row (SR) versus double-row (DR) arthroscopic rotator cuff repair. Overall, DR repair had a lower retear rate than SR (20.7% vs 11.9%, OR=1.88, 95% CI 1.33-2.66) and slightly better UCLA scores and forward flexion, but took longer to perform. When tears were stratified by size, DR's advantage in retear rate and functional scores (ASES, UCLA) was significant only for tears >30 mm, while for tears <30 mm there was no significant difference between techniques.
AI summary · from the full text · reviewed by Pukhraj Gaheer, Medical Student, Queen's University before publishing
Why it mattersThis helps surgeons decide when the extra time and cost of double-row fixation is justified: reserving it for larger tears while using the faster single-row technique for small-to-medium tears.
Conclusion strengthConfirms prior evidence
A clinically important harm: the entire 95% CI 1.33 to 2.66 is worse by more than a 2-point absolute difference of 2.
Presenting this at rounds? Start here
- ?Should surgeons routinely reserve double-row fixation for tears measuring 30 mm or larger and default to single-row repair for smaller tears to save operative time?
- ?How should the finding that double-row reduces partial-thickness but not full-thickness retears change how aggressively clinicians image and monitor small tears postoperatively?