Comparison between single-row and double-row rotator cuff repair: a biomechanical study

Area of Science:

• Orthopedic Surgery
• Biomechanical Engineering
• Sports Medicine

Background:

• Rotator cuff tears are common injuries affecting shoulder function.
• Suture anchor repair is a standard surgical technique.
• Understanding the biomechanical differences between single-row and double-row repairs is crucial for optimizing patient outcomes.

Purpose of the Study:

• To compare the mechanical behavior of single-row versus double-row rotator cuff repair using suture anchors.
• To evaluate repair integrity under cyclic loading in an ex-vivo porcine model.

Main Methods:

• Fifty porcine shoulders underwent simulated infraspinatus tendon tears.
• Repairs were performed using single-row (tension-free and tension) and double-row (tension-free and tension) techniques with metal suture anchors.
• Cyclic loading tests measured cycles to 5 mm elongation, cycles to failure, and total elongation.

Main Results:

• Single-row tension repair demonstrated significantly inferior mechanical properties compared to all other groups.
• Double-row repairs (both tension-free and tension) showed significantly greater resistance to cyclic displacement than single-row repairs.
• While not statistically different from each other, double-row repairs exhibited superior performance over single-row repairs in key mechanical metrics.

Conclusions:

• Double-row rotator cuff repair provides superior biomechanical strength and resistance to cyclic displacement compared to single-row repair.
• The double-row technique is recommended for large, unstable rotator cuff tears to enhance the mechanical stability of tendon-to-bone fixation.
• Single-row repairs, particularly when performed under tension, exhibit significant mechanical weaknesses.