Background: The retear rate following rotator cuff repair is
variable. Recent biomechanical studies have demonstrated that double-row
tendon-to-bone fixation excels in initial fixation strength and footprint
coverage compared with the single-row or transosseous fixation methods. This
study was designed to report the repair integrity and clinical outcome
following arthroscopic double-row rotator cuff repair.
Methods: A consecutive series of 106 patients with full-thickness
rotator cuff tears underwent arthroscopic double-row rotator cuff repair with
use of suture anchors and were followed prospectively. Twenty patients lacked
complete follow-up data or were lost to follow-up. The eighty-six study
subjects included fifty-two men and thirty-four women, with an average age of
60.5 years. There were twenty-six small, thirty medium, twenty-two large, and
eight massive tears. Clinical outcomes were evaluated at an average of
thirty-one months. Repair integrity was estimated with use of magnetic
resonance imaging, which was performed, on the average, fourteen months
postoperatively, and was classified into five categories, with type I
indicating sufficient thickness with homogeneously low intensity; type II,
sufficient thickness with partial high intensity; type III, insufficient
thickness without discontinuity; type IV, the presence of a minor
discontinuity; and type V, the presence of a major discontinuity.
Results: The average clinical outcome scores all improved
significantly at the time of the final follow-up (p < 0.01). At a mean of
fourteen months postoperatively, magnetic resonance imaging revealed that
thirty-seven shoulders had a type-I repair; twenty-one, a type-II repair;
thirteen, a type-III repair; eight, a type-IV repair; and seven, a type-V
repair. The overall rate of retears (types IV and V) was 17%. The retear rate
was 5% for small-to-medium tears, while it was 40% for large and massive
tears. The shoulders with a type-V repair demonstrated significantly inferior
functional outcome in terms of overall scores and strength compared with the
other types of repairs (p < 0.01).
Conclusions: Arthroscopic double-row repair can result in improved
repair integrity compared with open or miniopen repair methods. However, the
retear rate for shoulders with large and massive tears remains higher than
that for smaller tears, and shoulders with large repair defects (type V)
demonstrate significantly inferior functional outcomes.
Level of Evidence: Therapeutic Level IV. See Instructions
to Authors for a complete description of levels of evidence.