Purpose
Multiple meta-analyses of randomized clinical trials, the highest available level
of evidence, have been conducted to determine whether double-row (DR) or single-row
(SR) rotator cuff repair (RCR) provides superior clinical outcomes and structural
healing; however, results are discordant. The purpose of this study was to conduct
a systematic review of meta-analyses comparing SR and DR RCR to elucidate the cause
of discordance and to determine which meta-analysis provides the current best available
evidence.
Methods
In this study we evaluated available scientific support for SR versus DR RCR by systematically
reviewing the literature for published meta-analyses. Data were extracted from these
meta-analyses for patient outcomes and structural healing. Meta-analysis quality was
assessed with the Oxman-Guyatt and Quality of Reporting of Meta-analyses (QUOROM)
systems. The Jadad algorithm was then applied to determine which meta-analyses provided
the highest level of evidence.
Results
Eight meta-analyses met the eligibility criteria: 4 including Level I evidence and
4 including both Level I and Level II evidence. Six meta-analyses found no differences
between SR and DR RCR for patient outcomes, whereas 2 favored DR RCR for tears greater
than 3 cm. Two meta-analyses found no structural healing differences between SR and
DR RCR, whereas 3 found DR repair to be superior for tears greater than 3 cm and 2
found DR repair to be superior for all tears. Four meta-analyses had low Oxman-Guyatt
scores (<3) indicative of major flaws. After application of the Jadad algorithm, 3
concordant high-quality meta-analyses were selected, all of which found significantly
better structural healing with DR compared with SR RCR.
Conclusions
According to this systematic review of overlapping meta-analyses comparing SR and
DR RCR, the current highest level of evidence suggests that DR RCR provides superior
structural healing to SR RCR.
Level of Evidence
Level II, systematic review of Level I and II studies.
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Article info
Publication history
Published online: May 09, 2014
Accepted:
March 11,
2014
Received:
February 28,
2014
Footnotes
The authors report the following potential conflict of interest or source of funding: M.B. receives support from Eli Lilly, Smith & Nephew, Stryker, Johnson & Johnson. N.N.V. receives support from Smith & Nephew, Vindico Medical, Major League Baseball, Omeros. N.N.V. is part of a sports fellowship that receives support from Arthrex, Smith & Nephew, Ossur, and Linvatec. B.J.C. receives support from Arthrex, DJ Orthopaedics, Johnson & Johnson, Regentis, Zimmer, Medipost, Smith & Nephew (publication royalties), Carticept. A.A.R. receives support from Arthrex, DJO Surgical, Smith & Nephew, Ossur. A.A.R. received other financial support from Arthrex and DJO Surgical.
Identification
Copyright
© 2014 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.
