EVIDENCE-BASED REVIEWS & RECOMMENDATIONS FROM THE BRAZILIAN SOCIETY OF SHOULDER AND ELBOW SURGERY: DOUBLE-ROW REPAIR FOR LARGE ROTATOR CUFF TEARS

Abstract

ABSTRACT Introduction: Large (≥ 3 cm) rotator cuff tears have a poorer prognosis, and the optimal arthroscopic repair configuration (single-row vs double-row) remains controversial. Methods: We performed an evidence-based review of systematic reviews and randomized controlled trials comparing arthroscopic double-row and single-row repair for tears ≥ 3 cm. PubMed, Embase, the Cochrane Library, and BVS were searched through May 2025. Only studies reporting size-stratified outcomes were included. Methodological quality was assessed, and the certainty of evidence was graded using the GRADE approach. Results: Two high-quality systematic reviews and five randomized trials provided separate data for tears ≥ 3 cm. Double-row repair showed better functional outcomes than single-row repair, with improved ASES (MD −3.09; 95% CI −6.19 to 0.02) and UCLA scores (MD −1.47; 95% CI −2.21 to −0.72) (moderate-quality evidence). Limited randomized data suggested higher healing rates with double-row repair (OR 3.44; 95% CI 1.09–10.88; low-quality evidence). Pain alone did not differ meaningfully beyond the immediate postoperative period. Conclusions: For rotator cuff tears ≥ 3 cm, arthroscopic double-row repair provides superior functional outcomes and likely higher structural healing versus single-row repair, supporting its preferential use in large and massive tears, with decisions individualized to patient and lesion characteristics. Level of evidence II; Systematic review.