Related Experiment Video
Updated: Jul 19, 2026
Knotless Independent Double-Row Repair and Biceps Augmentation for Anterosuperior Rotator Cuff Tears
Published on: January 23, 2026
A biomechanical comparison of single and double-row fixation in arthroscopic rotator cuff repair
Christopher D Smith1, Susan Alexander, Adam M Hill
1The Shoulder Unit, Hospital of St. John and St. Elizabeth, 60 Grove End Road, London NWB 9NH, United Kingdom.
Background:
The optimal method for arthroscopic rotator cuff repair is not yet known. The hypothesis of the present study was that a double-row repair would demonstrate superior static and cyclic mechanical behavior when compared with a single-row repair. The specific aims were to measure gap formation at the bone-tendon interface under static creep loading and the ultimate strength and mode of failure of both methods of repair under cyclic loading.
Methods:
A standardized tear of the supraspinatus tendon was created in sixteen fresh cadaveric shoulders. Arthroscopic rotator cuff repairs were performed with use of either a double-row technique (eight specimens) or a single-row technique (eight specimens) with nonabsorbable sutures that were double-loaded on a titanium suture anchor. The repairs were loaded statically for one hour, and the gap formation was measured. Cyclic loading to failure was then performed.
Results:
Gap formation during static loading was significantly greater in the single-row group than in the double-row group (mean and standard deviation, 5.0 +/- 1.2 mm compared with 3.8 +/- 1.4 mm; p < 0.05). Under cyclic loading, the double-row repairs failed at a mean of 320 +/- 96.9 N whereas the single-row repairs failed at a mean of 224 +/- 147.9 N (p = 0.058). Three single-row repairs and three double-row repairs failed as a result of suture cut-through. Four single-row repairs and one double-row repair failed as a result of anchor or suture failure. The remaining five repairs did not fail, and a midsubstance tear of the tendon occurred.
Conclusions:
Although more technically demanding, the double-row technique demonstrates superior resistance to gap formation under static loading as compared with the single-row technique.
Clinical Relevance:
A double-row reconstruction of the supraspinatus tendon insertion may provide a more reliable construct than a single-row repair and could be used as an alternative to open reconstruction for the treatment of isolated tears.
