Arthroscopic rotator cuff techniques: Single-row, double-row, and the transosseous equivalent

Controversy exists regarding the optimal rotator cuff repair configuration. At arthroscopy, three major constructs are commonly used; single-row repair, double-row repair and transosseous equivalent or suture-bridge. To gain insight into optimal repair techniques, we critically reviewed both biomechanical and clinical outcome series evaluating these three techniques. Based upon the existing biomechanics studies, the double-row and suture-bridge techniques offer a clear advantage over singlerow repair when comparing initial load to failure. However, there is no consensus in the literature between the strength of doublerow and suture-bridge constructs. Suture-bridge constructs offer theoretical advantages of cuff compression and improving tendon bone interface (footprint contact) for optimal healing; however, clinical outcome studies have not yet proved this hypothesis. Clinical outcome studies, albeit few, demonstrate that in small tears, the clinical results of the three techniques are similar. In larger tears, both the clinical results and postoperative radiographic examinations suggest improved rates of healing with the double-row and transosseous equivalent techniques.