Knee Surgery, Sports Traumatology, Arthroscopy

, Volume 27, Issue 10, pp 3180–3187 | Cite as

Double-row rotator cuff repairs lead to more intensive pain during the early postoperative period but have a lower risk of residual pain than single-row repairs

  • Yuzhou Chen
  • Hong Li
  • Yang Qiao
  • Yunshen Ge
  • Yunxia Li
  • Yinghui Hua
  • Jiwu Chen
  • Shiyi ChenEmail author



The purpose of this study is to compare pain patterns and identify factors associated with residual shoulder pain after rotator cuff repairs using double-row and single-row techniques.


A cohort study was performed using patients who underwent arthroscopic rotator cuff repairs at our center in 2015. Patients were allocated according to the repair technique into an single-row (SR) group or a double-row (DR) group. Visual Analog Scale (VAS) scores for pain were assessed at 1 week, 3 months, 6 months, 12 months and 24 months after surgery. Functional and radiographic assessments were performed at least 24 months postoperatively. The proportion of patients with residual pain and factors associated with residual shoulder pain (VAS > 0 at the final follow-up) were analyzed in both groups.


Fifty-two patients were enrolled in the SR group, and 53 were enrolled in the DR group. The DR group appeared to have higher levels of pain 1 week (P < 0.001) and 3 months (P = 0.041) postoperatively, while at other time points, the pain intensity of the two groups was comparable. Fourteen (26.4%) and 25 (48.1%) patients in the DR and the SR groups, respectively, developed residual shoulder pain, (P = 0.022; RR 1.82). The univariate analysis and multiple regression revealed that a poorer quality of tendon tissue is related to residual pain in the SR group, whereas tendon retraction is associated with residual pain in the DR group. The rate of re-tear was similar between the two groups and between patients with and without residual pain.


The DR repair technique results in a greater intensity of pain than that of SR repair during the first 3 months after surgery; however, patients who underwent DR repair presented a significantly lower proportion of residual shoulder pain and better tendon quality after 2 years. Poorer tendon quality and larger tendon retraction as determined intraoperatively were risk factors for residual pain. These results highlight the necessity of promoting healing on the grounds of residual pain prevention.

Level of evidence



Rotator cuff Double row repair Residual pain Inflammation 



The research did not receive financial supports from fundings.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

The Institutional Review Board of Huashan Hospital Affiliated to Fudan University approved this study (IRB no. 2015-157).


  1. 1.
    Andersson G, Backman LJ, Christensen J et al (2017) Nerve distributions in insertional achilles tendinopathy—a comparison of bone, bursae and tendon. Histol Histopathol 3:263–270Google Scholar
  2. 2.
    Baums MH, Buchhorn GH, Spahn G et al (2008) Biomechanical characteristics of single-row repair in comparison to double-row repair with consideration of the suture configuration and suture material. Knee Surg Sports Traumatol Arthrosc 11:1052–1060CrossRefGoogle Scholar
  3. 3.
    Baums MH, Schminke B, Posmyk A et al (2015) Effect of single- and double-row rotator cuff repair at the tendon-to-bone interface: preliminary results using an in vivo sheep model. Arch Orthop Trauma Surg 1:111–118CrossRefGoogle Scholar
  4. 4.
    Bigliani LU, Morrison DS, April EW (1986) The morphology of the acromion and its relationship to rotator cuff tears. Orthop Trans 10:228Google Scholar
  5. 5.
    Carbonel I, Martinez AA, Calvo A et al (2012) Single-row versus double-row arthroscopic repair in the treatment of rotator cuff tears: a prospective randomized clinical study. Int Orthop 9:1877–1883CrossRefGoogle Scholar
  6. 6.
    Constant CR, Gerber C, Emery RJ et al (2008) A review of the Constant score: modifications and guidelines for its use. J Shoulder Elb Surg 2:355–361CrossRefGoogle Scholar
  7. 7.
    Constant CR, Murley AH (1987) A clinical method of functional assessment of the shoulder. Clin Orthop Relat Res 214:160–164Google Scholar
  8. 8.
    Cuff DJ, O’Brien KC, Pupello DR et al (2016) Evaluation of factors affecting acute postoperative pain levels after arthroscopic rotator cuff repair. Arthroscopy 7:1231–1236CrossRefGoogle Scholar
  9. 9.
    Davis ME, Stafford PL, Jergenson MJ et al (2015) Muscle fibers are injured at the time of acute and chronic rotator cuff repair. Clin Orthop Relat Res 1:226–232CrossRefGoogle Scholar
  10. 10.
    Davidson PA, Rivenburgh DW (2000) Rotator cuff repair tension as a determinant of functional outcome. J Shoulder Elb Surg 6:502–506CrossRefGoogle Scholar
  11. 11.
    Divani K, Chan O, Padhiar N et al (2010) Site of maximum neovascularisation correlates with the site of pain in recalcitrant mid-tendon achilles tendinopathy. Man Ther 5:463–468CrossRefGoogle Scholar
  12. 12.
    Dolkart O, Liron T, Chechik O et al (2014) Statins enhance rotator cuff healing by stimulating the COX2/PGE2/EP4 pathway: an in vivo and in vitro study. Am J Sports Med 12:2869–2876CrossRefGoogle Scholar
  13. 13.
    Freemont AJ, Peacock TE, Goupille P et al (1997) Nerve ingrowth into diseased intervertebral disc in chronic back pain. Lancet 350:178–181CrossRefGoogle Scholar
  14. 14.
    Fuchs B, Weishaupt D, Zanetti M, Hodler J, Gerber C (1999) Fatty degeneration of the muscles of the rotator cuff: assessment by computed tomography versus magnetic resonance imaging. J Shoulder Elb Surg 6:599–605CrossRefGoogle Scholar
  15. 15.
    Ge Y, Chen S, Chen J et al (2013) The development and evaluation of a new shoulder scoring system based on the view of patients and physicians: the Fudan University shoulder score. Arthroscopy 4:613–622CrossRefGoogle Scholar
  16. 16.
    Gerber C, Meyer DC, Schneeberger AG et al (2004) Effect of tendon release and delayed repair on the structure of the muscles of the rotator cuff: an experimental study in sheep. J Bone Jt Surg Am 9:1973–1982CrossRefGoogle Scholar
  17. 17.
    Gimbel JA, Mehta S, Van Kleunen JP et al (2004) The tension required at repair to reappose the supraspinatus tendon to bone rapidly increases after injury. Clin Orthop Relat Res 426:258–265CrossRefGoogle Scholar
  18. 18.
    Grasso A, Milano G, Salvatore M et al (2009) Single-row versus double-row arthroscopic rotator cuff repair: a prospective randomized clinical study. Arthroscopy 1:4–12CrossRefGoogle Scholar
  19. 19.
    Hein J, Reilly JM, Chae J et al (2015) Retear rates after arthroscopic single-row, double-row, and suture bridge rotator cuff repair at a minimum of 1 year of imaging follow-up: a systemic review. Arthroscopy 11:2274–2281CrossRefGoogle Scholar
  20. 20.
    Huberty DP, Schoolfiled JD, Brady PC et al (2009) Incidence and treatment of postoperative stiffness following arthroscopic rotator cuff repair. Arthroscopy 8:880–890CrossRefGoogle Scholar
  21. 21.
    Killian ML, Cavinatto LM, Ward SR et al (2015) Chronic degeneration leads to poor healing of repaired massive rotator cuff tears in rats. Am J Sports Med 10:2401–2410CrossRefGoogle Scholar
  22. 22.
    Kim CW, Kim JH, Kim DG (2014) The factors affecting pain pattern after arthroscopic rotator cuff repair. Clin Orthop Surg 6:392–400CrossRefGoogle Scholar
  23. 23.
    Kim DH, Jang YH, Choi YE et al (2016) Evaluation of repair tension in arthroscopic rotator cuff repair: does it really matter to the integrity of the rotator cuff? Am J Sports Med 11:2807–2812CrossRefGoogle Scholar
  24. 24.
    Kim YK, Moon SH, Cho SH (2013) Treatment outcomes of single- versus double-row repair for larger than medium-sized rotator cuff tears: the effect of preoperative remnant tendon length. Am J Sports Med 10:2270–2277CrossRefGoogle Scholar
  25. 25.
    Ma HL, Chiang E-R, Wu H-TH et al (2012) Clinical outcome and imaging of arthroscopic single-row and double-row rotator cuff repair: a prospective randomized trial. Arthroscopy 1:16–24CrossRefGoogle Scholar
  26. 26.
    Michener LA, McClure PW, Sennett BJ (2002) American Shoulder and Elbow Surgeons standardized shoulder assessment form, patient self-report section: reliability, validity, and responsiveness. J Shoulder Elb Surg 6:587–594CrossRefGoogle Scholar
  27. 27.
    Millett PJ, Warth RJ, Dornan GJ et al (2014) Clinical and structural outcomes after arthroscopic single-row versus double-row rotator cuff repair: a systematic review and meta-analysis of level I randomized clinical trials. J Shoulder Elb Surg 4:586–597CrossRefGoogle Scholar
  28. 28.
    Nicholas SJ, Lee SJ, Mullaney MJ, Tyler TF, Fukunaga T, Johnson CD et al (2016) Functional outcomes after double-row versus single-row rotator cuff repair: a prospective randomized trial. Orthop J Sports Med 10:2325967116667398Google Scholar
  29. 29.
    Nelson CO, Sileo MJ, Grossman MG et al (2008) Single-row modified mason-allen versus double-row arthroscopic rotator cuff repair: a biomechanical and surface area comparison. Arthroscopy 8:941–948CrossRefGoogle Scholar
  30. 30.
    Oh JH, Kim SH, Lee HK (2008) Moderate preoperative shoulder stiffness does not alter the clinical outcome of rotator cuff repair with arthroscopic release and manipulation. Arthroscopy 9:983–991CrossRefGoogle Scholar
  31. 31.
    Park JY, Lhee SH, Choi JH et al (2008) Comparison of the clinical outcomes of single and double row repairs in rotator cuff tears. Am J Sports Med 36:1310–1316CrossRefGoogle Scholar
  32. 32.
    Santoni BG, McGilvray KC, Lyons AS et al (2010) Biomechanical analysis of an ovine rotator cuff repair via porous patch augmentation in a chronic rupture mode. Am J Sports Med 4:679–686CrossRefGoogle Scholar
  33. 33.
    Simon CB, Coronado RA, Greenfield WH III, Valencia C, Wright TW, Moser MW, Farmer KW, George SZ (2016) Predicting pain and disability after shoulder arthroscopy: rotator cuff tear severity and concomitant arthroscopic procedures. Clin J Pain 5:404–410CrossRefGoogle Scholar
  34. 34.
    Shin SJ, Kook SH, Rao N et al (2015) Clinical outcomes of modified Mason-Allen single-row repair for bursal-sided partial-thickness rotator cuff tears: comparison with the double-row suture-bridge technique. Am J Sports Med 8:1976–1982CrossRefGoogle Scholar
  35. 35.
    Sugaya H, Maeda K, Matsuki K et al (2005) Functional and structural outcome after arthroscopic full-thickness rotator cuff repair: single-row versus dual-row fixation. Arthroscopy 11:1307–1316CrossRefGoogle Scholar
  36. 36.
    Tudisco C, Bisicchia S, Savarese E et al (2013) Single-row vs. double-row arthroscopic rotator cuff repair: clinical and 3 T MR arthrography results. BMC Musculoskelet Disord 14:43CrossRefGoogle Scholar
  37. 37.
    Xu Y, Bonar F, Murrell GAC (2011) Neoinnervation in rotator cuff tendinopathy. Sports Med Arthrosc Rev 4:354–359CrossRefGoogle Scholar
  38. 38.
    Yeo DYT, Walton JR, Lam P et al (2017) The Relationship between intraoperative tear dimensions and postoperative pain in 1624 consecutive arthroscopic rotator cuff repairs. Am J Sports Med 4:788–793CrossRefGoogle Scholar

Copyright information

© European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA) 2019

Authors and Affiliations

  1. 1.Department of Sports MedicineHuashan Hospital Affiliated to Fudan UniversityShanghaiChina
  2. 2.Department of RadiologyHuashan Hospital Affiliated to Fudan UniversityShanghaiChina

Personalised recommendations