Evaluation of Residual Rotator Cuff Defects After In Vivo Single- Versus Double-Row Rotator Cuff Repairs

Purpose: As arthroscopic rotator cuff surgery has advanced, new techniques have emerged to maximize the biomechanical strength of the repair construct. The double-row repair has been recommended as a means of increasing the contact area of the repaired rotator cuff to the native bone bed. This study attempts to sequentially examine and measure the rotator cuff footprint (in vivo) before cuff repair, after an initial lateral-row repair (before the medial-row sutures are tied), and finally, after the double-row repair. In this way, the rotator cuff footprint of single- and double-row repairs can be quantified and compared. Methods: Between October 2004 and February 2005, 26 patients were enrolled in the study. These patients had rotator cuff tears that were amenable to double-row repair by means of performing the lateral-row repair before the medial-row repair. After preparation of the greater tuberosity footprint, the native footprint was measured in the medial-to-lateral direction. Next, the medial-row anchors and sutures were passed through the cuff (but not tied), and then the lateral row was secured via suture anchors and the arthroscope was reinserted into the intra-articular space. A depth gauge was introduced through the repaired cuff (lateral row only), and the residual bare footprint was measured. The medial row was then tied, and the cuff was again visualized from the intra-articular position to measure any remaining bare footprint. Results: The mean footprint measured 17.0 ± 1.9 mm from medial to lateral. After repair of the lateral row, the mean residual uncovered footprint measured 9.0 ± 2.0 mm. This constituted a 52.7% ± 9.2% uncovered area after a single lateral-row repair. After the medial row was secured, there were no remaining residual deficits of the cuff footprint. Conclusions: After an isolated lateral-row repair, 52.7% ± 9.2% of the rotator cuff footprint remains uncovered. On average, the double-row repair offered over twice the footprint coverage yielded by a single-row repair. Clinical Relevance: The arthroscopic shoulder surgeon should be aware of the enhanced footprint coverage offered by double-row rotator cuff fixation as opposed to single-row rotator cuff fixation.