Original article
Functional and Structural Outcome After Arthroscopic Full-Thickness Rotator Cuff Repair: Single-Row Versus Dual-Row Fixation

https://doi.org/10.1016/j.arthro.2005.08.011Get rights and content

Purpose: The purpose of this study was to compare the functional as well as the structural outcomes of single-row and dual-row fixation after arthroscopic full-thickness rotator cuff repair. Type of Study: Retrospective cohort study. Methods: A consecutive series of 80 shoulders in 78 patients with full-thickness rotator cuff tears was evaluated using the rating scale of the University of California Los Angeles (UCLA) and the shoulder index of the American Shoulder and Elbow Surgeons (ASES) at an average of 35 months (range, 24 to 60 months) after arthroscopic rotator cuff repair. Thirty-nine shoulders were repaired using the single-row technique and 41 shoulders using the dual-row technique. Postoperative cuff integrity was determined through magnetic resonance imaging and was classified into 5 categories: type I, sufficient thickness with homogenously low intensity; type II, sufficient thickness with partial high intensity; type III, insufficient thickness without discontinuity; type IV, presence of a minor discontinuity; type V, presence of a major discontinuity. Results: The average UCLA score improved significantly to 32.4 in the single-row and to 33.1 in the dual-row group. The ASES shoulder index improved significantly to 93.0 in the single-row group and to 94.6 in the dual-row group. However, there was no statistical difference between the groups in the postoperative scores. Postoperative MRI revealed 11 type I, 6 type II, 12 type III, 4 type IV, and 6 type V in the single-row group, and 22 type I, 8 type II, 7 type III, 4 type IV, and no type V in the dual-row group. A statistical difference was observed between the groups (P < .01). Conclusions: Arthroscopic rotator cuff repair yielded successful functional outcomes without significant difference between single and dual-row fixation techniques. However, dual-row repairs excelled in structural outcome over the single-row technique. Level of Evidence: Level III.

Section snippets

Patient Selection

From February 1999 to April 2002, 132 consecutive shoulders in 130 patients who failed conservative treatment underwent arthroscopic primary rotator cuff repair by a single surgeon (H.S.). Full-thickness or partial-thickness defects were confirmed by preoperative MRI in all patients. The criteria for inclusion in this study were a full-thickness rotator cuff tear confirmed during surgery and no major associated pathology that would need to be addressed at the time of arthroscopic surgery, such

Functional Outcome

Both rating systems reflected a significant improvement in the status of the shoulders when the preoperative scores were compared with those at the time of the final follow-up (P < .01). The average total score increased from preoperative 14.8 (range, 3-22) to 32.4 (range, 16-35) in the single-row group and from 14.4 (range, 5-21) to 33.1 (range, 19-35) in the dual-row group with use of the UCLA rating scale. The average total score improved from 45.8 (range, 5-70) to 93.0 (range, 45-100) in

Discussion

Although patient population and surgical technique were different, Galatz et al.10 recently reported a surprisingly poor structural outcome after arthroscopic large and massive rotator cuff tears. In their series, 17 of 18 patients (94%) had a recurrent defect as evaluated through ultrasonography performed 2 years postoperatively. They mentioned that arthroscopic repair of the rotator cuff might not yield as strong a repair as traditional open or mini-open repair. They also suggested that an

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