Double-Row Rotator Cuff Repairs

Advances in surgical technique and implants for arthroscopic rotator cuff repair have generated an interest in the indications and application of doubleand singlerow repairs. Recently, a variation of the double-row technique, known as the transosseous equivalent repair, has also been described. Previous reports of unacceptably high failure rates after arthroscopic repair of large and massive rotator cuff tears have led to the scrutiny of both this technique and the implants used. Biomechanically, double-row techniques are superior to single-row with respect to restoring the anatomic footprint, minimizing gap formation, and providing a greater load to failure at time equals zero. Furthermore, the recently described transosseous equivalent fixation technique provides improved footprint restoration, greater contact pressure across the bone-tendon interface, and an increased load to failure when compared to doublerow repair. Although the biomechanical data are encouraging, clinical studies are still in progress to assess the efficacy of double-row versus single-row techniques, particularly with regard to tendon healing. The potential advantages may be offset by the added surgical time, required technical expertise, and potential increase in cost. The purpose of this study is to review the biomechanical, histological, and in vivo results of double-row and transosseous equivalent arthroscopic rotator cuff repairs while also discussing our indications and technique for double-row repairs.