• Philipp R Heuberer, Leo Pauzenberger, Michael S Gruber, Roman C Ostermann, Michael Hexel, Brenda Laky, and Werner Anderl.
• Vienna Shoulder and Sports Clinic, Vienna, Austria.
• Am J Sports Med. 2020 Mar 1; 48 (3): 689-696.

BackgroundThe rotator cuff is known to consist of 2 macroscopically visible layers that have different biomechanical properties. Sometimes the inferior layer may be neglected during rotator cuff repair. However, it is controversial whether double-layer (DL) repair is superior to single-layer (SL) repair in terms of retear rate and outcome.PurposeTo investigate whether DL as compared with SL repair could decrease retear rates after arthroscopic reconstruction of posterosuperior rotator cuff tears.Study DesignRandomized controlled trial; Level of evidence, 1.MethodsA total of 70 patients were 1:1 randomized to receive an arthroscopic DL reconstruction (study group: DL suture-bridge repair) or SL reconstruction (control group: SL suture-bridge repair) for posterosuperior tears of the rotator cuff between 2.0 and 3.5 cm of the footprint detachment. Exclusion criteria were subscapularis tendon rupture (Lafosse >1°), fatty muscular infiltration >2°, and nondelaminated tendons. Tendon integrity according to Sugaya, fatty degeneration, and muscular atrophy were evaluated by magnetic resonance tomography. Pre- and postoperative evaluations included the Constant score, range of motion, American Shoulder and Elbow Surgeons score, Simple Shoulder Test, subjective shoulder value, and postoperative satisfaction with the procedure. Complications were monitored throughout the study.ResultsNinety percent of patients (n = 34, DL; n = 29, SL) were followed-up. There were no significant group differences regarding baseline characteristics and pre- and postoperative fatty degeneration of the supraspinatus and atrophy of the supraspinatus and infraspinatus. The rate of magnetic resonance-verified intact repairs (Sugaya grades 1 + 2) was significantly higher in the DL group (70.6%) than in the SL group (44.8%; P = .045). One patient in the control group with a retear underwent revision. All functional and subjective scores improved significantly pre- to postoperatively in both groups (P < .05). No significant group differences were detected regarding postoperative Constant score, forward flexion, external rotation, American Shoulder and Elbow Surgeons score, Simple Shoulder Test, subjective shoulder value, and visual analog scale and between intact and retorn tendons. The majority of patients were very satisfied or satisfied with their arthroscopic procedure (DL, 94.1%; SL, 92.9%).ConclusionThis randomized controlled trial showed significantly lower retear rates after DL repair as compared with SL repair in delaminated rotator cuff tears. Clinical short-term outcome was not different between the DL and SL repair groups.RegistrationNCT003362320 (ClinicalTrials.gov identifier).

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