Functional Outcomes After Double-Row Versus Single-Row Rotator Cuff Repair

Background: The functional benefits of double-row (DR) versus single-row (SR) rotator cuff repair are not clearly established. Purpose: To examine the effect of DR versus SR rotator cuff repair on functional outcomes and strength recovery in patients with full-thickness tears. Study Design: Randomized controlled trial; Level of evidence, 2. Methods: Forty-nine patients were randomized to DR or SR repairs; 36 patients (13 women, 23 men; mean age, 62 +/- 7 years; 20 SR, 16 DR) were assessed at a mean 2.2 +/- 1.6 years after surgery (range, 1-7 years; tear size: 17 medium, 13 large, 9 massive). The following data were recorded prior to surgery and at follow-up: Penn shoulder score, American Shoulder and Elbow Surgeons (ASES), and Simple Shoulder Test (SST) results; range of motion (ROM) for shoulder flexion, external rotation (ER) at 0 degrees and 90 degrees of abduction, and internal rotation (IR) at 90 degrees of abduction; and shoulder strength (Lafayette manual muscle tester) in empty-and full-can tests, abduction, and ER at 0 degrees of abduction. Treatment (SR vs DR) x time (pre-vs postoperative) mixed-model analysis of variance was used to assess the effect of rotator cuff repair. Results: Rotator cuff repair markedly improved Penn, ASES, and SST scores (P < .001), with similar improvement between SR and DR repairs (treatment x time, P = .38-.10) and excellent scores at follow-up (DR vs SR: Penn, 91 +/- 11 vs 92 +/- 11 [P = .73]; ASES, 87 +/- 12 vs 92 +/- 12 [P = .21]; SST, 11.4 +/- 1.0 vs 11.3 +/- 1.0 [P = .76]). Patients with DR repairs lost ER ROM at 0 degrees of abduction (preoperative to final follow-up, 7 degrees +/- 10 degrees loss [P = .013]). ER ROM did not significantly change with SR repair (5 degrees +/- 14 degrees gain, P = .16; treatment by time, P = .008). This effect was not apparent for ER ROM at 90 degrees of abduction (treatment x time, P = .26). IR ROM improved from preoperative to final follow-up (P <.01; SR, 17 degrees +/- 27 degrees; DR, 7 degrees +/- 21 degrees; treatment x time, P = .23). Rotator cuff repair markedly improved strength in empty-can (54%), full-can (66%), abduction (47%), and ER (54%) strength (all P < .001), with no difference between SR and DR repairs (P = .23-.75). All clinical tests with the exception of the lift-off test were normalized at follow-up (P < .05). Conclusion: Outcomes were not different between SR or DR repair, with generally excellent outcomes for both groups. Rotator cuff repair and subsequent rehabilitation markedly improved shoulder strength.