My orthopedic surgeon is planning to do arthroscopic surgery to repair my torn rotator cuff. She showed me how it will be done and I watched a video of someone else's surgery. I noticed in the movie the surgeons mentioned using a double-row of stitches for better healing and stability. My own surgeon said she uses single-row sutures. Do you think I should ask for the double method? Does it matter?
Surgeons are grappling with the question of whether to use single-row sutures to repair a torn rotator cuff or if the results might be better with a double-row? Some studies have shown that a double row of sutures provides greater stability and biomechanical strength. But similar studies to prove the clinical value (e.g., fewer complications, better shoulder function) are lacking.
Both single-row and double-row suture technique can be done arthroscopically without a wide open incision. Arthroscopic surgery is less invasive and involves less cutting into the soft tissues such as muscles and tendons. The benefit in the end is less scarring, less pain, fewer injuries to important soft tissues such as muscles.
Double-row sutures brings more of the tendon in contact with the bone. The hope is that more fibers will be recruited in the healing process. This might result in a more stable repair. Double-row sutures also means less stress and force are applied to each individual suture. There is also the potential for less gapping in the soft tissues where they should be smooth and closely reattached to the bone.
A recent study from Boston University School of Medicine took a closer look at the question of which approach is better (single versus double-row sutures). The surgeons there conducted a systematic review, which means they searched all previously published articles on this topic to see if there was any consensus or agreement from the studies done so far. They found seven suitable studies to include in their analysis.
Although they found a trend toward more failures in the single-row group, it wasn't significant enough to say single-row sutures is an inferior repair method compared with double-row sutures. The retear rate, number of complications, and functional outcomes were not statistically different between the two suture repair techniques. There was a trend toward a higher retear rate among the single-row group. But again, this difference did not reach statistical significance. The mechanically superior double-row fixation simply does not improve the final results.
The authors concluded that further study of this topic is needed. They suggested that perhaps rotator cuff tear site, size, and quality make a difference and should be included in the analysis.
Alexander M. DeHaan, MD, et al. Does Double-Row Rotator Cuff Repair Improve Functional Outcome of Patients Compared with Single-Row Technique? A Systematic Review. In The American Journal of Sports Medicine. May 2012. Vol. 40. No. 5. Pp. 1176-1185.
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