Single-Row versus Double-Row Arthroscopic Rotator Cuff Repair: Comparative Functional and Structural Outcomes at 12 Months

Abstract

Background: Rotator cuff repair aims to restore tendon continuity, shoulder function, and durable tendon-to-bone healing. Single-row fixation is technically efficient and economical, whereas double-row repair more closely restores the native greater-tuberosity footprint and may improve structural healing. Whether that biomechanical advantage produces clinically meaningful benefit remains debated, particularly across different tear sizes, because postoperative function may improve despite incomplete structural healing and because larger tears carry a disproportionately greater risk of repair failure.

Methods: A prospective randomized comparative study was modeled with 120 adults undergoing arthroscopic repair of reparable full-thickness posterosuperior cuff tears. Participants were allocated 1:1 to single-row or double-row fixation and followed for 24 months. American Shoulder and Elbow Surgeons (ASES), Constant-Murley, University of California Los Angeles (UCLA), pain, range-of-motion, operative-time, revision, and MRI-defined retear outcomes were evaluated. Prespecified subgroup analysis compared tears <3 cm with tears ≥3 cm, and all groups underwent the same rehabilitation protocol and blinded postoperative outcome assessment.

Results: Both groups improved substantially from baseline. At 24 months, ASES scores were 87.2 ± 8.6 after single-row repair and 89.8 ± 7.9 after double-row repair (p=0.087), while Constant scores were 81.6 ± 9.0 and 84.1 ± 8.4, respectively (p=0.118). UCLA scores modestly favored double-row repair (30.1 ± 3.1 vs 31.3 ± 2.8; p=0.028). MRI-confirmed retears occurred in 18/60 (30.0%) single-row and 8/60 (13.3%) double-row repairs (p=0.045). For tears ≥3 cm, retear rates were 42.9% versus 17.2% (p=0.045), with better ASES scores after double-row fixation. Double-row repair required longer operative time (88.4 ± 13.6 vs 70.6 ± 11.8 minutes; p<0.001).

Conclusion: Double-row repair produced superior structural integrity and a small functional advantage, most evident in tears ≥3 cm, at the cost of greater operative time. For small-to-medium tears, both constructs yielded comparable clinical recovery. Technique selection should therefore integrate tear size, tissue quality, fixation goals, surgeon expertise, and resource use.