A Meta-Analysis Of Single-Row Versus Double-Row Suture In Rotator Cuff Repair

Background:Rotator cuff tear is one of the common diseases of shoulder joint injury in middle-aged and elderly people.At present,the main treatment methods for rotator cuff tear are arthroscopic surgery,among which single-row fixation,double-row fixation and suture bridge fixation are the most common.However,there is no clear conclusion about which fixation method has better efficacy.Objective:To evaluate the clinical efficacy of single-row(SR)and double-row(DR)arthroscopic fixation in the treatment of rotator cuff tear by meta-analysis,and to compare the advantages and disadvantages of the two methods,so as to obtain more accurate and reliable results,To provide reference for clinical treatment of rotator cuff tear.Methods:Collect and manage literature by computer using Endnote 20 software data engine.Six databases including Embase,PubMed,Web of Science,Cochrane Library,Wanfang Database,CNKI and VIP were systematically searched from the establishment of the database to January 2022.The Chinese and English literatures are related to the efficacy of single-row arthroscopic fixation and double-row arthroscopic fixation in the treatment of rotator cuff tears.Data were extracted from the included studies and statistically analyzed by RevMan5.4.The evaluation indexes included postoperative rotator cuff tissue retear rate,American Shoulder and Elbow Surgeons(ASES)score,Constant shoulder Function score,and The Shoulder from The University of California,USA Rating Scale of the University of California at Los Angeles,UCLA),visual analogue Score(VAS),WORC Score(The Western on-Tario Rotator cuff index score,shoulder range of motion include external rotation Angle,internal rotation Angle,forward flexion Angle and abduction Angle.Results:A total of 34 literatures(2144 cases)were included in this study.There were 1084 patients in the single-row fixation group and 1060 patients in the double-row fixation group.In the comparison of overall postoperative shoulder function score and range of motion of shoulder in rotator cuff tear patients,UCLA score(WMD=-0.85,P=0.01),flexion Angle(WMD=-6.63,P<0.00001),abduction Angle(WMD=-9.17,P=0.006),Rotator cuff retear rate(RR=2.09,P<0.00001),the therapeutic effect of double-row fixation was significantly better than that of single-row fixation,while ASES score(WMD=-0.88,P=0.26),VAS(WMD=0.34,P=0.46),WORC(WMD=2.59,P=0.21),Constant(WMD=-0.21,P=0.74),external rotation Angle(WMD=-0.57,P=0.42),internal rotation Angle(WMD=-3.85,P=0.10),double row fixation and single row fixation had no significant difference.As for the comparison of various shoulder function scores of rotator cuff tears<3cm,ASES(WMD=-1.23,P=0.12),Constant(WMD=2.86,,P=0.27),UCLA(WMD=-0.49,P=0.39)showed no significant difference between double-row fixation and single-row fixation.As for the comparison of various shoulder function scores of rotator cuff tears>3cm,ASES(WMD=-3.88,P=0.0002),Constant(WMD=-5.53,P=0.01),UCLA(WMD=-2.20,P<0.0001)showed that double-row fixation was superior to single-row fixation.Conclusion:Compared with single row fixation,double-row fixation can reduce the recurrence rate of rotator cuff tear,and the flexion Angle and abduction Angle of shoulder joint can be better recovered.In patients with rotator cuff tears less than 3cm,there was no significant difference in the functional score of shoulder after single row fixation and double row fixation,while in patients with rotator cuff tears greater than 3cm,double row suture could achieve better functional score of shoulder.