• Randy Mascarenhas, Peter N Chalmers, Eli T Sayegh, Mohit Bhandari, Nikhil N Verma, Brian J Cole, and Anthony A Romeo.
• Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A.. Electronic address: mascarer@hotmail.com.
• Arthroscopy. 2014 Sep 1; 30 (9): 1156-65.

PurposeMultiple 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.MethodsIn 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.ResultsEight 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.ConclusionsAccording 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 EvidenceLevel II, systematic review of Level I and II studies.Copyright © 2014 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

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