Current Concepts in Rotator Cuff Repair Techniques. Biomechanical, Functional, and Structural Outcomes
Comparative Analysis of Different Surgical Techniques Used in Rotator Cuff Repair
The paper titled “Comparative Analysis of Different Surgical Techniques Used in Rotator Cuff Repair“ provides an in-depth examination of various surgical techniques used in rotator cuff repair, focusing on their biomechanical properties, healing and retear rates, and clinical outcomes. The techniques discussed include single-row repair, double-row repair, and transosseous equivalent (TOE) repair.
The paper highlights that most studies support the biomechanical superiority of double-row repair over single-row repair due to its stronger structure, higher initial and failure strength, increased footprint contact pressure, and lesser gap formation risk. The TOE technique, which has gained popularity recently, has also been shown to improve contact features at the rotator cuff footprint, create higher pressure at the tendon–bone interface, and increase failure strength compared to conventional double-row repair.
Healing and Retear Rates
The retear rates following arthroscopic repair can vary widely, with rates approaching 94% reported for large and massive tears. However, most retears detected after surgery are generally asymptomatic and are thought not to contribute significantly to functional outcomes. The general consensus in the literature is that the biomechanical superiorities of double-row repair demonstrated in experimental environments carry over to healing capacity and lead to lower retear rates.
While double-row repair techniques yield superior results compared to single-row techniques in terms of biomechanical properties and retear rates, there are question marks regarding the contribution of these advantages to functional outcomes. Many prospective clinical trials have reported that single- and double-row repairs show no differences in terms of functional outcomes. However, especially for large and massive tears, the number of studies reporting better functional outcomes with double-row repairs cannot be ignored.
Meta-Analyses and Randomized Controlled Studies
Several meta-analyses and randomized controlled studies have been conducted to compare the outcomes of different surgical techniques used in rotator cuff repair. For instance, a meta-analysis by Chen et al. found that tendon healing is better in double-row repair compared to single-row repair, especially among tears larger than 3 cm. Another meta-analysis by Millett et al. found higher retear rates among single-row repairs (25.9%) compared to double-row repairs (14.2%). However, most of these meta-analyses reported similar functional outcomes between single-row and double-row repairs.
In conclusion, the paper suggests that single-row repair may be adequate for small-medium sized tears, while double-row and TOE repair techniques could be superior for providing structural integrity in large and massive tears. However, due to the increased costs and prolonged intraoperative time associated with double-row repairs, the cost-effectiveness of these techniques should be considered. Future studies with high levels of evidence could provide better guidance on the choice of surgical technique for rotator cuff repair.