Design: Systematic review and meta-analysis of 18 randomised trials
Population: 1,308 patients undergoing arthroscopic rotator cuff repair
Primary outcome: Retear rate
Effect: Single- vs double-row retear OR 1.88 (95% CI 1.33 to 2.66); no difference for tears under 30 mm

A systematic review and meta-analysis of randomised trials in Arthroscopy (24 August 2026) compared single-row with double-row arthroscopic rotator cuff repair across 18 trials and 1,308 patients, with a planned subgroup analysis by tear size at 30 mm.

Overall, single-row repair was associated with nearly twice the odds of retear (odds ratio 1.88) and slightly worse UCLA scores and forward flexion, with low heterogeneity. Double-row repair took longer. The subgroup analysis is where the decision lies: for tears of 30 mm or more, double-row repair was better on function scores and retear; for tears under 30 mm, there was no meaningful difference.

The subgroup split was prespecified and consistent, which makes it more credible than most. Retear is partly a radiological end point, and a retear is not always symptomatic. For a surgeon, it supports matching construct to tear: double-row for large tears, the quicker and cheaper single-row repair for small and medium ones.

Measure tear size before choosing the repair construct.
Consider double-row repair for tears of 30 mm or more.
Single-row repair is a reasonable choice for tears under 30 mm, with shorter operating time and fewer anchors.
Counsel that retear seen on imaging does not always mean a poor clinical result.

Why it matters

It replaces a blanket preference for double-row with a size threshold, which matters where anchors are paid for out of pocket.

The statistics, in plain English

An odds ratio of 1.88 means the odds of retear were nearly twice as high with single-row repair. An I² of 27% means the trials broadly agreed. Subgroup results are usually weaker than the overall result, but here the size threshold was planned in advance.