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Triple-Loaded Single-Row versus Suture-Bridge Double-Row Rotator Cuff Tendon Repair with Platelet Rich Plasma Fibrin Membrane: A Randomized Control Trial

      Introduction

      to compare the structural healing and clinical outcomes of triple-loaded single-row to suture-bridging double-row repairs of full thickness rotator cuff tears both augmented with platelet rich plasma fibrin membrane (PRPFM).

      Methods

      A prospective, randomized, consecutive series of full-thickness rotator cuff tears under 3cm in AP length were treated with either a triple-loaded single-row (20) or suture-bridging double-row (20) repair augmented with PRPFM. Randomization took place by opening a sealed envelope in the operating room after confirming the patient’s eligibility. The primary outcome measure was cuff integrity determined by MRIs obtained 12 months postop interpreted by radiologists blinded to the study. Cho criteria were used to assess tears. Secondary outcome measures were American Shoulder and Elbow Surgeons, Rowe, Simple Shoulder Test, Constant, and Single Assessment Numeric Evaluation scores. An a priori power analysis was used to determine group size

      Results

      MRI and outcome scores were obtained in 40 patients (mean clinical follow-up 27 months and mean MRI interval 12.6 months). 3 of 20 single-row repairs (15%) and 3 of 20 double-row repairs (15%) had tears at follow up MRI. The single-row group had retears in 1 single tendon repair and 2 double tendon repairs. All 3 tears failed at the original attachment site (Cho type 1). In the double-row group, retears were found in 3 double tendon repairs. All 3 tears failed near the musculotendinous junction (Cho type 2). All clinical outcome measures were significantly improved from the preoperative level (p<0.0001), but there was no statistical difference between groups postoperatively

      Conclusion

      There is no MRI difference in 12 month rotator cuff retear rates between triple-loaded single-row repairs or suture-bridging double-row repairs. Double-row repairs failed at the musculotendinous junction while single-row repairs failed at the reattachment site. No difference could be demonstrated between in clinical outcome scores either.