The rotator cuff is a major group of connective muscles and tendons in the shoulder. Many baseball players tear their rotator cuffs in either the pitching or sliding motion and surgery is the only way to reconnect the frayed muscles to the humerus and the scapula. In the past years, rotator cuff surgery has become a routine orthopedic procedure and can now be performed entirely arthroscopically. The tendon is reattached to the bone and can be done using either the single- or double-row technique. Single-row repairs are most common, but recent literature has begun looking into the benefits of double-row arthroscopy. Dr. Wall et al in their November, 2009 systematic review, “Clinical Outcomes of Double-Row Versus Single-Row Rotator Cuff Repairs”, attempt to answer this question. Published in Arthroscopy: The Journal of Arthroscopic and Related Surgery, this study looks at data from both types of repairs.
Although both single-row and double-row repairs successfully repair the rotator cuff, there is question as to whether or not the double-row repair improves biomechanics of the shoulder in the long run. This study concludes that there is no short-term difference, but further studies are necessary to look into the long-term effects. These doctors suggest that MRI and CT be used to assess the initial size of the tear and thereby determine if it is big enough for double-row techniques to have a positive impact. Double-row techniques require more fixation, and thereby more anchors and sutures into the shoulder, which promotes better re-growth, but makes the surgery more expensive, technically more difficult, and much longer. Because of the advanced technology in fixation devices and anchors, it is possible to attach the rotator cuff more forcefully to the bone and have a better outcome (double-row technique), but it has yet to be determined if this in fact is the case. The dependency on tear size of the success of these techniques complicates the nature of the study and requires more data to determine if double-row fixation is, in fact, superior to single-row rotator cuff repair.
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