Arthroscopic Rotator Cuff Repair with Double-Row Fixation

Pol E. Huijsmans, Mark P. Pritchard, Bart M. Berghs, Karin S. van Rooyen, Andrew L. Wallace, and Joe F. de Beer
J Bone Joint Surg Am. 2007; 89:1248-1257

Surgical treatment of indicated rotator cuff tears has undergone a sea change from open surgical repairs to arthroscopic repairs. This study reviewed results of arthroscopic rotator cuff repairs with the newly described double-row, or footprint, reconstruction technique. A cadaveric study revealed superior initial strength and less gap formation with double-row fixation compared to the single-row fixation method.

264 patients were studied, who underwent an arthroscopic rotator cuff repair with double-row fixation over a period of five years. The average age at the time of the operation was 59 years. 238 patients (242 shoulders) were available for follow-up; 210 were evaluated with a full clinical examination and 32, with a questionnaire only. Preoperative and postoperative examinations consisted of determination of a Constant score, a visual analogue score for pain and a full physical examination of the shoulder. An ultrasound scan was done at an average of 12 months postoperatively to assess the integrity of the cuff.

The outcomes demonstrated improvement in pain and an excellent subjective outcome in almost 90.9% of patients who underwent this procedure. The average increase in the shoulder score (Constant) score was 25.4 points Strength and active elevation were significantly higher in the group with an intact repair at the time of follow-up than in the group with a failed repair. Interestingly there was no difference however, in the pain scores.

There are some salient points about the double-row technique namely:

• Excellent visualisation is required for this technique to be undertaken.
• If excessive traction is required for the reduction or closure of the tear in the cuff, a perilabral capsuloto- my is performed with the arthroscopic elevator in the anterolateral portal.
• Anchors are placed medially and laterally over the footprint after clearing the footprint of all soft tissues
• When the medial sutures are passed, the laminated deep part of the tendon is pulled laterally to its original insertion, following which the superficial part of the tendon is pulled more laterally to cover the footprint.
• The double-row fixation eliminates the windshield- wiper phenomenon (of the repaired tendon moving up from its footprint with movements of the arm).
• The slight disadvantage of the double-row sutures has been the increased cost of the suture anchors and the increased operating time.