Summary of Literature



Test Type




Cummins et al

Arthroscopy 2005[1]

Tensile Strength test sheep Supraspinatus

2 suture anchors double loaded and a simple stitch suture pattern = 212 +/- 39 N; P < .001

5 suture anchors in a double-row configuration, single loaded, that grasped the tendon with mattress stitches = 336 +/- 59 N; P < .001

“the initial load to failure of a rotator cuff repair may be increased by increasing the number of suture anchors, the number of sutures per anchor, or using suture patterns that grab more adjacent tendon fibers”

Mazzoca et al.

Am J Sports Med, 2005 [2]

load to failure

No difference


“Double-row techniques provide a larger footprint width; although not addressed by this study, such a factor may improve the biological quality of repair.” – Why?


cyclic displacement

No difference



anatomical footprint



Tuoheti et al.

Am J Sports Med, 2005 [3]

Contact area


60% greater



Contact pressure

16% (P = .03)

18% (P = .014)
No significant difference between the single-row and double-row techniques (P = .915)


Brady et al.

Arthroscopy 2006 [4]

Footprint coverage at repair measure with depth gauge


50% greater coverage of footprint


Kim et al.

Am J Sports Med 2006  [5]

cyclic loading from 10 to 180 N for 200 cycles, followed by tensile testing to failure.





Gap formation
First cycle

Last cycle


3.10 +/- 1.67 mm

7.64 +/- 3.74 mm


1.67 +/- 0.75 mm

3.58 +/- 2.59 mm (P < .05)





initial strain over the footprint area for the double-row repair was nearly one third (P < .05)





Increased by 46%



Ultimate failure load


Increased by 48%


Ma et al.

JBJSA 2006 [6]

cyclically loaded between 5 and 100 N at 0.25 Hz for fifty cycles and then loaded to failure under displacement control at 1 mm/sec



Failure mechanisms were similar for all stitches



No significant differences were found among the stitches with respect to conditioning elongation.

The mean peak-to-peak elongation (and standard error of the mean) was significantly lower for the massive cuff (1.1 +/- 0.1 mm) and double-row stitches (1.1 +/- 0.1 mm) than for the arthroscopic Mason-Allen stitch (1.5 +/- 0.2 mm) (p < 0.05)


The ultimate tensile load

191 +/- 18 N (2 simple)

250 +/- 21 N (massive cuff)

287 +/- 24 N (p < 0.05)



No difference


JSES 2006 [7]

Footprint area



“may provide a tendon-bone interface better suited for biologic healing and restoring normal anatomy”


Arthroscopy 2006 [8]

5 N to 180 N at a rate of 33 mm/sec. The test was stopped when complete failure (repair site gap of 10 mm) or a total of 5,000 cycles was attained



address some deficiencies in current methods by increasing the strength of the repair, potentially leading to improved healing rates


Cycles to failure

798.3 +/- 73.28



Fixation strength


Stronger (p<0.001)

Smith et al.

JBJSA 2006 [9]

loaded statically for one hour, and the gap formation was measured. Cyclic loading to failure was then performed



Three single-row repairs and three double-row repairs failed as a result of suture cut-through. Four single-row repairs and one double-row repair failed as a result of anchor or suture failure


Gap formation

5.0 +/- 1.2 mm

3.8 +/- 1.4 mm


Cyclic loading to failure

224 +/- 147.9 N

320 +/- 96.9 N (p = 0.058)







Functional Score



Charousset et al. 2007 [11]

Clinical, controlled prospective trial of 60 patients with Constant score and CT arthrography

Constant score:

Single row improved from 53.6 to 82.7

Double row improved from 56.6 to 80.7 (p<0.05)

CT Arthrography:

Watertight healing was obtained in 77.4% of the cases in the double-anchorage group and in 60% of the cases in the single-anchorage group, this difference was not significant

No significant difference between single and double row.

Franceschi et al. 2007 [10]

Clinical, controlled prospective trial of 60 patients with UCLA score and MR arthrography

No difference in UCLA scores

MR arthrography in single row goup showed intact tendons in 14 patients, partial-thickness defects in 10 patients, and full-thickness defects in 2 patients. In the double row group, magnetic resonance arthrography showed an intact rotator cuff in 18 patients, partial-thickness defects in 7 patients, and full-thickness defects in 1 patient.

No significant difference between single and double row.






1.          Cummins, C.A., et al., Rotator cuff repair: an ex vivo analysis of suture anchor repair techniques on initial load to failure. Arthroscopy, 2005. 21(10): p. 1236-41.

2.          Mazzocca, A.D., et al., Arthroscopic single-row versus double-row suture anchor rotator cuff repair. Am J Sports Med, 2005. 33(12): p. 1861-8.

3.          Tuoheti, Y., et al., Contact area, contact pressure, and pressure patterns of the tendon-bone interface after rotator cuff repair. Am J Sports Med, 2005. 33(12): p. 1869-74.

4.       Brady, P.C., P. Arrigoni, and S.S. Burkhart, Evaluation of residual rotator cuff defects after in vivo single- versus double-row rotator cuff repairs. Arthroscopy, 2006. 22(10): p. 1070-5.

5.       Kim, D.H., et al., Biomechanical comparison of a single-row versus double-row suture anchor technique for rotator cuff repair. Am J Sports Med, 2006. 34(3): p. 407-14.

6.       Ma, C.B., et al., Biomechanical evaluation of arthroscopic rotator cuff repairs: double-row compared with single-row fixation. J Bone Joint Surg Am, 2006. 88(2): p. 403-10.

7.       Meier, S.W. and J.D. Meier, Rotator cuff repair: the effect of double-row fixation on three-dimensional repair site. J Shoulder Elbow Surg, 2006. 15(6): p. 691-6.

8.       Meier, S.W. and J.D. Meier, The effect of double-row fixation on initial repair strength in rotator cuff repair: a biomechanical study. Arthroscopy, 2006. 22(11): p. 1168-73.

9.       Smith, C.D., et al., A biomechanical comparison of single and double-row fixation in arthroscopic rotator cuff repair. J Bone Joint Surg Am, 2006. 88(11): p. 2425-31.

10. Francesco Franceschi, Laura Ruzzini, Umile Giuseppe Longo, Francesca Maria Martina, Bruno Beomonte Zobel, Nicola Maffulli, and Vincenzo Denaro Equivalent Clinical Results of Arthroscopic Single-Row and Double-Row Suture Anchor Repair for Rotator Cuff Tears: A Randomized Controlled Trial. Am J Sports Med 2007 35: 1254-1260.

11. Christophe Charousset, Jean Grimberg, Louis Denis Duranthon, Laurance Bellaiche, and David Petrover. Can a Double-Row Anchorage Technique Improve Tendon Healing in Arthroscopic Rotator Cuff Repair?: A Prospective, Nonrandomized, Comparative Study of Double-Row and Single-Row Anchorage Techniques With Computed Tomographic Arthrography Tendon Healing Assessment. Am J Sports Med 2007 35: 1247-1253.




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