A retrospective study of the clinical efficacy of arthroscopic double-row and single-row suture-bridge techniques for rotator cuff tears

Abstract

The comparative efficacy of single-row (SR) and double-row (DR) suture-bridge techniques in arthroscopic rotator cuff repair remains controversial, particularly with regard to optimal patient selection. This study aimed to compare the early clinical outcomes of the two techniques and, importantly, to perform subgroup analyses according to tear size to identify the patient populations most likely to benefit from the DR technique. A total of 144 patients were retrospectively assigned to the DR group (n = 73) or SR group (n = 71) according to the surgical technique used. Perioperative parameters, visual analogue scale (VAS) scores, Constant-Murley scores (CMS), American Shoulder and Elbow Surgeons (ASES) scores, University of California at Los Angeles (UCLA) shoulder scores, and range of motion (ROM) were compared between the two groups before surgery and at the final follow-up. Magnetic resonance imaging (MRI) was performed 12 months postoperatively to assess the rotator cuff retear rate. Subgroup analyses were conducted after stratification into small-to-medium (SM) and large-to-massive (LM) tear groups. Operative time and intraoperative blood loss were greater in the DR group than in the SR group, with statistically significant differences between the groups (P = 0.007). Postoperatively, functional scores and VAS scores improved significantly from baseline in both groups (P < 0.05). Compared with the SR group, the DR group demonstrated significantly greater improvements in VAS, CMS, UCLA, and ASES scores (all P < 0.001). Assessment of shoulder ROM and imaging outcomes also showed significantly greater improvements in the DR group than in the SR group (P < 0.05). Subgroup analysis revealed that the functional benefits of the DR technique were primarily attributable to patients with LM tears, in whom the improvements exceeded the minimal clinically important difference (MCID). In contrast, for patients with SM tears, the clinical relevance of the observed between-group differences was less definitive. Arthroscopic double-row suture-bridge repair is associated with superior early functional recovery and a lower retear rate than the single-row technique. However, these benefits appear to be driven primarily by outcomes in patients with large-to-massive tears. For small-to-medium tears, the clinically meaningful advantage of the DR technique is less evident, suggesting that tear size may be an important determinant when selecting the surgical repair technique.