LAHAINA, Hawaii — The controversy of double-row arthroscopic rotator cuff repair compared with single-row repair still exists, according to a speaker at Orthopedics Today Hawaii 2017.
“Here is our challenge: Understanding double-row is better than single-row and it is from a biomechanical perspective. Biology is important. Clinical results are what matter the most. We also have to be sensitive to cost and how technically hard the operation is. Complications might be different between the two that we should also respect,” Christopher S. Ahmad, MD, said.
Christopher S. Ahmad
Ahmad said the goal of rotator cuff repair is to optimize the mechanical environment between the tendon and bone.
“The mechanical environment — [from the perspective of] a repair strategy — is a race. It is a race to biologically heal. If it does not biologically heal, whatever our construct is will fall apart, just like fracture repairs. We need a great biologic environment with our mechanical construct and that should be part of our goal,” he said.
He said biomechanical studies have shown double-row rotator cuff repair has better fixation strength, footprint restoration, compression and interface motion. However, the understanding of vascularity needs to be better. Clinical results have shown better healing with double-row repair and size matters. Clinical results have not been shown to be different and cost analyses involve huge assumptions, he said.
“So here is the question, ‘Is double-row better than single-row?’ Biomechanically, I think, yes. Biologically, I think, yes. Clinically, I think we have to wait and see. The cost and technical — I am not sure if a single study has proven to me that it is not cost-effective. Complications — There were a unique set of complications with these double-row [studies], but now we have learned about how to manage them.” – by Kristine Houck, MA, ELS
Ahmad CS. Double-row rotator cuff repair evidence made simple. Presented at: Orthopedics Today Hawaii 2017; Jan. 8-12, 2017; Lahaina, Hawaii.
Disclosure: Ahmad reports he receives basic science support from Arthrex and Smith & Nephew; is a consultant for Arthrex; and receives royalties from Arthrex and Lead Player Publishing.