ISAKOS Congress 2021

2021 ISAKOS Biennial Congress Paper

 

A Multicenter Randomized Controlled Trial Comparing Single-Row With Double-Row Fixation In Arthroscopic Cuff Repair: Long Term Follow-Up

Peter Lapner, MD, FRCSC, Ottawa, ON CANADA
Ang Li, MD FRCSC, Ottawa, Ontario CANADA
J Whitcomb Pollock, MD FRCSC, Ottawa, Ontario CANADA
Tinghua Zhang, MSc, Ottawa CANADA
Katie McIlquham, Ottawa, ON CANADA
Sheila McRae, PhD, MSc, Winnipeg, MB CANADA
Peter B. MacDonald, MD, FRCS, Dip Sport Med, Winnipeg, MB CANADA

The Ottawa Hospital, Ottawa, CANADA

FDA Status Not Applicable

Summary

Purpose: compare the effects of single versus double-row suture techniques in arthroscopic repair of tears of the rotator cuff at 10 year follow up. No statistically significant differences in functional outcomes were seen between groups at 10 years. Analysis of 2-year to 10-year change scores demonstrated a decrease in WORC scores in the single row group not observed in the double row group

Abstract

Background

The long term comparative outcomes of single row versus double row fixation in arthroscopic rotator cuff repair is not currently known.

Purpose

To compare the treatment effects of single versus double-row suture techniques in arthroscopic repair of full thickness tears of the rotator cuff at 10 year follow up.
Study Design: Multicenter randomized controlled trial

Methods

Patients were evaluated at 10 years post-operatively. The primary outcome measure was the Western Ontario Rotator Cuff index (WORC). Secondary outcome measures included the American Shoulder and Elbow Surgeons score (ASES), Constant score, and incidence of revision surgery. Ultrasound was used to evaluate the rotator cuff to determine repair integrity. Statistical analyses consistent with those of the main trial were applied.

Results

Of the original 90 participants, 75 (83%) returned at a mean follow-up of 10 years. There were no statistical or clinically significant differences found between single and double-row fixation at final long-term follow-up. Comparison of change in WORC scores from 2-year to 10-year follow-up within groups demonstrated little difference in the double-row group (1.1, 95%CI -10.3-12.5, p=0.85) but a significant decrease in the single-row group (14.7, 95%CI 5.14-24.4, p=0.003). Similarly, a decrease in the ASES scores was observed between 2 and 10 years in the single-row group (11.6, 95%CI 2.9-20.2, p=0.009), as well as decrease in both single and double-row Constant scores (10.6, 95%CI 1.5-19.7, p=0.02 and 15.8, 95%CI 5.-26.3 p=0.003) respectively. Three participants developed a full-thickness tear after 2 years, two from the double-row group, and one from the single-row group. One participant from each study group underwent revision surgery after the 2-year time-point.

Conclusions

No statistically significant differences in quality or functional outcomes were identified between single-row and double-row fixation techniques at long-term follow-up at 10 years. Between 2- and 10-year follow-up, a decrease in several outcome measures were observed in both the single-row and double-row groups. Analysis of 2-year to 10-year change scores demonstrated a decrease in WORC and ASES scores in the single row group not observed in the double row group.

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