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

  • Giuseppe MilanoEmail author
  • Andrea Grasso
  • Donatella Zarelli
  • Laura Deriu
  • Mario Cillo
  • Carlo Fabbriciani


The aim of this study was to compare the mechanical behavior under cyclic loading test of single-row and double-row rotator cuff repair with suture anchors in an ex-vivo animal model. For the present study, 50 fresh porcine shoulders were used. On each shoulder, a crescent-shaped full-thickness tear of the infraspinatus was performed. Width of the tendon tear was 2 cm. The lesion was repaired using metal suture anchors. Shoulders were divided in four groups, according the type of repair: single-row tension-free repair (Group 1); single-row tension repair (Group 2); double-row tension-free repair (Group 3); double-row tension repair (Group 4); and a control group. Specimens were subjected to a cyclic loading test. Number of cycles at 5 mm of elongation and at failure, and total elongation were calculated. Single-row tension repair showed significantly poorest results for all the variables considered, when compared with the other groups. Regarding the mean number of cycles at 5 mm of elongation and at failure, there was a nonsignificant difference between Groups 3 and 4, and both of them were significantly greater than Group 1. For mean total elongation, the difference between Groups 1, 3, and 4 was not significant, but all of them were significantly lower than the control group. A single-row repair is particularly weak when performed under tension. Double-row repair is significantly more resistant to cyclic displacement than single-row repair in both tension-free and tension repair. Double-row repair technique can be primarily considered for large, unstable rotator cuff tears to improve mechanical strength of primary fixation of tendons to bone.


Rotator cuff Repair Suture anchors Double-row Biomechanics 


  1. 1.
    Abbi G, Espinoza L, Odell T, Mahar A, Pedowitz R (2006) Evaluation of 5 knots and 2 suture materials for arthroscopic rotator cuff repair: very strong sutures can still slip. Arthroscopy 22:38–43PubMedCrossRefGoogle Scholar
  2. 2.
    Apreleva M, Ozbaydar M, Fitzgibbons PG, Warner JJ (2002) Rotator cuff tears: the effect of the reconstruction method on three-dimensional repair site area. Arthroscopy 18:519–526PubMedCrossRefGoogle Scholar
  3. 3.
    Buess E, Steuber KU, Waibl B (2005) Open versus arthroscopic rotator cuff repair: a comparative view of 96 cases. Arthroscopy 21:597–604PubMedCrossRefGoogle Scholar
  4. 4.
    Burkhart SS, Esch JC, Jolson RS (1993) The rotator crescent and rotator cable: An anatomic description of the shoulder’s “suspension bridge.”. Arthroscopy 9:611–616PubMedCrossRefGoogle Scholar
  5. 5.
    Cummins CA, Appleyard RC, Strickland S, Haen PS, Chen S, Murrell GA (2005) Rotator cuff repair: an ex vivo analysis of suture anchor repair techniques on initial load to failure. Arthroscopy 21:1236–1241PubMedCrossRefGoogle Scholar
  6. 6.
    De Carli A, Vadala A, Monaco E, Labianca L, Zanzotto E, Ferretti A (2005) Effect of cyclic loading on new polyblend suture coupled with different anchors. Am J Sports Med 33:214–219PubMedCrossRefGoogle Scholar
  7. 7.
    Demirhan M, Atalar AC, Kilicoglu O (2003) Primary fixation strength of rotator cuff repair techniques: a comparative study. Arthroscopy 19:572–576PubMedCrossRefGoogle Scholar
  8. 8.
    Dugas JR, Campbell DA, Warren RF, Robie BH, Millett PJ (2002) Anatomy and dimensions of rotator cuff insertions. J Shoulder Elbow Surg 11:498–503PubMedCrossRefGoogle Scholar
  9. 9.
    Fealy S, Kingham TP, Altchek DW (2002) Mini-open rotator cuff repair using a two-row fixation technique: outcomes analysis in patients with small, moderate, and large rotator cuff tears. Arthroscopy 18:665–670PubMedCrossRefGoogle Scholar
  10. 10.
    Galatz LM, Ball CM, Teefey SA, Middleton WD, Yamaguchi K (2004) The outcome and repair integrity of completely arthroscopically repaired large and massive rotator cuff tears. J Bone Joint Surg Am 86:219–224PubMedGoogle Scholar
  11. 11.
    Goutallier D, Postel JM, Gleyze P, Leguilloux P, Van Driessche S (2003) Influence of cuff muscle fatty degeneration on anatomic and functional outcomes after simple suture of full-thickness tears. J Shoulder Elbow Surg 12:550–554PubMedCrossRefGoogle Scholar
  12. 12.
    Halder AM, O’Driscoll SW, Heers G, Mura N, Zobitz ME, An KN, Kreusch-Brinker R (2002) Biomechanical comparison of effects of supraspinatus tendon detachments, tendon defects, and muscle retractions. J Bone Joint Surg Am 84:780–785PubMedGoogle Scholar
  13. 13.
    Harryman DT II, Mack LA, Wang KY, Jackins SE, Richardson ML, Matsen FA III (1991) Repairs of the rotator cuff: correlation of functional results with integrity of the cuff. J Bone Joint Surg Am 73:982–989PubMedGoogle Scholar
  14. 14.
    Ide J, Maeda S, Takagi K (2005) A comparison of arthroscopic and open rotator cuff repair. Arthroscopy 21:1090–1098PubMedCrossRefGoogle Scholar
  15. 15.
    Jost B, Zumstein M, Pfirrmann CW, Gerber C (2006) Long-term outcome after structural failure of rotator cuff repairs. J Bone Joint Surg Am 88:472–479PubMedCrossRefGoogle Scholar
  16. 16.
    Kim DH, Elattrache NS, Tibone JE, Jun BJ, DeLaMora SN, Kvitne RS, Lee TQ (2006) Biomechanical comparison of a single-row versus double-row suture anchor technique for rotator cuff repair. Am J Sports Med 34:407–414PubMedCrossRefGoogle Scholar
  17. 17.
    Liu SH, Baker CL (1994) Arthroscopically assisted rotator cuff repair: correlation of functional results with integrity of the cuff. Arthroscopy 10:54–60PubMedCrossRefGoogle Scholar
  18. 18.
    Lo IK, Burkhart SS (2004) Arthroscopic repair of massive, contracted, immobile, rotator cuff tears using single and double interval slides: technique and preliminary results. Arthroscopy 20:22–33PubMedCrossRefGoogle Scholar
  19. 19.
    Lo IKY, Burkhart SS (2003) Double-row arthroscopic rotator cuff repair: re-establishing the footprint of the rotator cuff. Arthroscopy 19:1035–1072PubMedCrossRefGoogle Scholar
  20. 20.
    Ma CB, Comerford L, Wilson J, Puttlitz CM (2006) Biomechanical evaluation of arthroscopic rotator cuff repairs: double-row compared with single-row fixation. J Bone Joint Surg Am 88:403–410PubMedCrossRefGoogle Scholar
  21. 21.
    Ma CB, MacGillivray JD, Clabeaux J, Lee S, Otis JC (2004) Biomechanical evaluation of arthroscopic rotator cuff stitches. J Bone Joint Surg Am 86:1211–1216PubMedGoogle Scholar
  22. 22.
    Martin RB, Burr DB, Sharkey NA (1998) Skeletal tissue mechanics. Springer, New YorkGoogle Scholar
  23. 23.
    Mazzocca AD, Millett PJ, Guanche CA, Santangelo SA, Arciero RA (2005) Arthroscopic single-row versus double-row suture anchor rotator cuff repair. Am J Sports Med 33:1861–1868PubMedCrossRefGoogle Scholar
  24. 24.
    Meier SW, Meier JD (2006) Rotator cuff repair: the effect of double-row fixation on three-dimensional repair site. J Shoulder Elbow Surg 15:691–696PubMedCrossRefGoogle Scholar
  25. 25.
    Meyer DC, Fucentese SF, Koller B, Gerber C (2004) Association of osteopenia of the humeral head with full-thickness rotator cuff tears. J Shoulder Elbow Surg 13:333–337PubMedCrossRefGoogle Scholar
  26. 26.
    Roddey TS, Cook KF, O’Malley KJ, Gartsman GM (2005) The relationship among strength and mobility measures and self-report outcome scores in persons after rotator cuff repair surgery: impairment measures are not enough. J Shoulder Elbow Surg 14(1 Suppl):95S–98SPubMedCrossRefGoogle Scholar
  27. 27.
    Ruotolo C, Fow JE, Nottage WM (2004) The supraspinatus footprint: an anatomic study of the supraspinatus insertion. Arthroscopy 20:246–249PubMedCrossRefGoogle Scholar
  28. 28.
    Schneeberger AG, von Roll A, Kalberer F, Jacob HA, Gerber C (2002) Mechanical strength of arthroscopic rotator cuff repair techniques: an in vitro study. J Bone Joint Surg Am 84:2152–2160PubMedGoogle Scholar
  29. 29.
    Severud EL, Ruotolo C, Abbott DD, Nottage WM (2003) All-arthroscopic versus mini-open rotator cuff repair: a long-term retrospective outcome comparison. Arthroscopy 19:234–238PubMedCrossRefGoogle Scholar
  30. 30.
    Sugaya H, Maeda K, Matsuki K, Moriishi J (2005) Functional and structural outcome after arthroscopic full-thickness rotator cuff repair: single-row versus dual-row fixation. Arthroscopy 21:1307–1316PubMedCrossRefGoogle Scholar
  31. 31.
    Tauro JC (1999) Arthroscopic “interval slide” in the repair of large rotator cuff tears. Arthroscopy 15: 527–530PubMedCrossRefGoogle Scholar
  32. 32.
    Thomazeau H, Boukobza E, Morcet N, Chaperon J, Langlais F (1997) Prediction of rotator cuff repair results by magnetic resonance imaging. Clin Orthop Relat Res 344:275–283PubMedCrossRefGoogle Scholar
  33. 33.
    Tuoheti Y, Itoi E, Yamamoto N, Seki N, Abe H, Minagawa H, Okada K, Shimada Y (2005) Contact area, contact pressure, and pressure patterns of the tendon-bone interface after rotator cuff repair. Am J Sports Med 33:1869–1874PubMedCrossRefGoogle Scholar
  34. 34.
    Waltrip RL, Zheng N, Dugas JR, Andrews JR (2003) Rotator cuff repair: a biomechanical comparison of three techniques. Am J Sports Med 31:493–497PubMedGoogle Scholar
  35. 35.
    Warner JJ, Tetreault P, Lehtinen J, Zurakowski D (2005) Arthroscopic versus mini-open rotator cuff repair: a cohort comparison study. Arthroscopy 21:328–332PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2007

Authors and Affiliations

  • Giuseppe Milano
    • 1
    Email author
  • Andrea Grasso
    • 2
  • Donatella Zarelli
    • 3
  • Laura Deriu
    • 1
  • Mario Cillo
    • 1
  • Carlo Fabbriciani
    • 1
  1. 1.Department of Orthopaedics and TraumatologyCatholic UniversityRomeItaly
  2. 2.Department of OrthopaedicsVilla Valeria ClinicRomeItaly
  3. 3.Department of OrthopaedicsUniversity of SassariSassariItaly

Personalised recommendations