Arthroscopic double-row rotator cuff repair: a comprehensive review of the literature.

Nuri Aydin,Mahmut Kursat Ozsahin,Bedri Karaismailoglu,Mert Gurcan

doi:10.1051/sicotj/2018048

Abstract

Rotator cuff repairs seek to achieve adequate tendon fixation and to secure the fixation during the process of biological healing. Currently, arthroscopic rotator cuff repair has become the gold standard. One of the earliest defined techniques is single-row repair but the inadequacy of single-row repair to precisely restore the anatomical footprint as well as the significant rates of retear especially in large tears have led surgeons to seek other techniques. Double-row repair techniques, which have been developed in response to these concerns, have various modifications like the number and placement of anchors and suture configurations.When the literature is reviewed, it is possible to say that double-row repairs demonstrate superior biomechanical properties. In regard to retear rates, both double row and transosseous equivalent (TOE) techniques have also yielded more favorable outcomes compared to single-row repair. But the clinical results are conflicting and more studies have to be conducted. However, it is more probable that superior structural integrity will yield better structural and functional results in the long run. TOE repair technique is regarded as promising in terms of better biomechanics and healing since it provides better footprint contact. Knotless TOE structures are believed to reduce impingement on the medial side of tendons and thus aid in tendon nutrition; however, there are not enough studies about its effectiveness.It is important to optimize the costs without endangering the treatment of the patients. We believe that the arthroscopic TOE repair technique will yield superior results in regard to both repair integrity and functionality, especially with tears larger than 3 cm. Although defining the pattern of the tear is one of the most important guiding steps when selecting the repair technique, the surgeon should not forget to evaluate every patient individually for tendon healing capacity and functional expectations.

Highlights

The surgical treatment of rotator cuff tears, which can hinder the daily activities and the quality of life significantly and cause significant pain, has been practiced for years and improvements to surgical techniques are constantly achieved
Various techniques like open surgery and mini open surgery have been frequently used in the past, currently, the use of arthroscopic rotator cuff repair has become the gold standard owing to the development of arthroscopic techniques
The development of arthroscopic double-row rotator cuff repair, which was defined by Lo and Burkhart [4] in 2003, has opened a new era in the treatment of rotator cuff tears

Summary

Introduction

The surgical treatment of rotator cuff tears, which can hinder the daily activities and the quality of life significantly and cause significant pain, has been practiced for years and improvements to surgical techniques are constantly achieved. The authors have proposed that with this technique, a wider restoration of the anatomic footprint could be achieved, the repair strength would be higher, there would be less stress on the anchors and knots and better healing rates could be achieved. Since it is a more complicated and expensive surgery, questions regarding the cost effectiveness of double-row repairs were raised after some studies found similar functional outcomes of single-row and double-row techniques. In 2006, Park et al [5] have defined the

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