Double‐Row Repair Improves Outcomes for Large Rotator Cuff Tears but Offers No Advantage for Small‐to‐Medium Tears: A Systematic Review and Meta‐analysis of Randomised Controlled Trials
Arthroscopy The Journal of Arthroscopic and Related Surgery · 24 Aug 2026
† Impact is the editorial-priority score. All scores are out of 100. Clinical is a stored clinical-importance score from the earlier method; it has not been recalculated.
Why it matters
This helps surgeons decide when the extra time and cost of double-row fixation is justified: reserving it for larger tears while using the faster single-row technique for small-to-medium tears.
The evidence
This meta-analysis pooled 18 randomised trials (1,308 patients) comparing single-row (SR) versus double-row (DR) arthroscopic rotator cuff repair. Overall, DR repair had a lower retear rate than SR (20.7% vs 11.9%, OR=1.88, 95% CI 1.33-2.66) and slightly better UCLA scores and forward flexion, but took longer to perform. When tears were stratified by size, DR's advantage in retear rate and functional scores (ASES, UCLA) was significant only for tears >30 mm, while for tears <30 mm there was no significant difference between techniques.
overall retear rate: Odds ratio 1.88 (95% CI 1.33 to 2.66; units not reported). The interval favours the comparator; the size of the disadvantage needs clinical interpretation.
Why this rigour score?
Meta-analysis of RCTsDesign starting point: 60.8
Raised the score
- Prospectively registered+5.1
- Pools randomised trials+5.1
Lowered the score
No negative adjustments recorded.
Methods at a glance
Recorded assessment- Comprehensive literature searchMet
- Risk of bias assessedMet
- Bias considered in synthesisMet
- Publication bias assessedMet
- Study exclusions justifiedMet
- Prospective registrationMet
Not reported does not mean not done. Checks have different weights; this is not a count of boxes ticked.
See the full score breakdown
- Study design starting point
- 60.8
- Compared against an accepted alternative
- +1.7
- 0% loss to follow-up
- +1.7
- Prospectively registered
- +5.1
- Pools randomised trials
- +5.1
- Comprehensive literature search
- +3.4
- Risk of bias assessed in the included studies
- +3.4
- Risk of bias carried into the synthesis
- +2.5
- Excluded studies listed and justified
- +1.7
- Publication bias assessed
- +2.5
- Final rigour score rounded
- 88 / 100
Study design sets the starting point and a ceiling of 96. Recorded methods then adjust the score. Points are shown to one decimal place; the final score uses unrounded values.
Checklist from the stored appraisal. “Not met” describes the recorded criterion; it does not always produce a deduction. This overview supports reading the full study.
For journal club
1.Should surgeons routinely reserve double-row fixation for tears measuring 30 mm or larger and default to single-row repair for smaller tears to save operative time?
2.How should the finding that double-row reduces partial-thickness but not full-thickness retears change how aggressively clinicians image and monitor small tears postoperatively?
Original publication title
Double‐Row Repair Improves Outcomes for Large Rotator Cuff Tears but Offers No Advantage for Small‐to‐Medium Tears: A Systematic Review and Meta‐analysis of Randomized Controlled Trials