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Scientific Articles   |    
A Multicenter Randomized Controlled Trial Comparing Single-Row with Double-Row Fixation in Arthroscopic Rotator Cuff Repair
Peter L.C. Lapner, MD, FRCSC1; Elham Sabri, MSc2; Kawan Rakhra, MD, FRCSC1; Sheila McRae, MSc3; Jeff Leiter, PhD3; Kimberly Bell, BA1; Peter MacDonald, MD, FRCSC3
1 Division of Orthopaedics (P.L.C.L. and K.B.), Department of Diagnostic Imaging (K.R.), The Ottawa Hospital, General Campus, 501 Smyth Road, W1648, Box 502, Ottawa, ON K1H 8L6, Canada. E-mail address for P.L.C. Lapner: plapner@toh.on.ca. E-mail address for K. Rakhra: krakhra@toh.on.ca. E-mail address for K. Bell: kibell@toh.on.ca
2 Methods Centre, Clinical Epidemiology Program, Ottawa Hospital Research Institute, 501 Smyth Road, Box 208, Room W0590, Ottawa, ON K1H 8L6, Canada. E-mail address: esabri@ohri.ca
3 Pan Am Clinic, 75 Poseidon Bay, Winnipeg, MB R3M 3E4, Canada. E-mail address for S. McRae: smcrae@panamclinic.com. E-mail address for J. Leiter: jleiter@panamclinic.com. E-mail address for P. MacDonald: pmacdonald@panamclinic.com
View Disclosures and Other Information
Disclosure: None of the authors received payments or services, either directly or indirectly (i.e., via his or her institution), from a third party in support of any aspect of this work. One or more of the authors, or his or her institution, has had a financial relationship, in the thirty-six months prior to submission of this work, with an entity in the biomedical arena that could be perceived to influence or have the potential to influence what is written in this work. No author has had any other relationships, or has engaged in any other activities, that could be perceived to influence or have the potential to influence what is written in this work. The complete Disclosures of Potential Conflicts of Interest submitted by authors are always provided with the online version of the article.

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Investigation performed at The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, the Pan Am Clinic, Winnipeg, Manitoba, and the University of Manitoba, Winnipeg, Manitoba, Canada

A commentary by Diane L. Dahm, MD, is linked to the online version of this article at jbjs.org.


Copyright © 2012 by The Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2012 Jul 18;94(14):1249-1257. doi: 10.2106/JBJS.K.00999
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Abstract

Background: 

Controversy exists regarding the optimal technique for arthroscopic rotator cuff repair. The purpose of this multicenter, randomized, double-blind controlled study was to compare the functional outcomes and healing rates after use of single-row and double-row suture techniques for repair of the rotator cuff.

Methods: 

Ninety patients undergoing arthroscopic rotator cuff repair were randomized to receive either a single-row or a double-row repair. The primary objective was to compare the Western Ontario Rotator Cuff Index (WORC) score at twenty-four months. Secondary objectives included comparison of the Constant and American Shoulder and Elbow Surgeons (ASES) scores and strength between groups. Anatomical outcomes were assessed with magnetic resonance imaging (MRI) or ultrasonography to determine the postoperative healing rates.

Results: 

Baseline demographic data including age (p = 0.29), sex (p = 0.68), affected side (p = 0.39), and rotator cuff tear size (p = 0.28) did not differ between groups. The WORC score did not differ significantly between groups at any time point (p = 0.48 at baseline, p = 0.089 at three months, p = 0.52 at six months, p = 0.83 at twelve months, and p = 0.60 at twenty-four months). The WORC score at each postoperative time point was significantly better than the baseline value. The Constant score, ASES score, and strength did not differ significantly between groups at any time point. Logistic regression analysis demonstrated that a smaller initial tear size and double-row fixation were associated with higher healing rates.

Conclusions: 

No significant differences in functional or quality-of-life outcomes were identified between single-row and double-row fixation techniques. A smaller initial tear size and a double-row fixation technique were associated with higher healing rates as assessed with ultrasonography or MRI.

Level of Evidence: 

Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.

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    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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