Type 2 retear after arthroscopic single-row, double-row and suture bridge rotator cuff repair: a systematic review

Eur J Orthop Surg Traumatol. 2019 Feb;29(2):373-382. doi: 10.1007/s00590-018-2306-8. Epub 2018 Sep 18.


Aim/purpose: To provide a systematic review of the literature on patterns of retear after single-row (SR), double-row (DR) and suture bridge (SB) techniques.

Methods: The PubMed and MEDLINE databases were searched for published articles reporting both repair technique and retear pattern. Studies in languages other than English, those reporting open rotator cuff repair as the index procedure, as well as animal and cadaveric studies and those which did not describe patterns of retear, were excluded. MINORS scoring system was used to quantify potential bias in each study. Retears were classified into type 1 (failure at the tendon-bone interface) and type 2 (medial cuff failure). For all studies included, number and type of retears after different repair techniques were reported and analyzed.

Results: Fourteen studies were included yielding a total of 260 rotator cuff retears. Repair technique had a significant impact on the estimated incidence rate of type 2 retear (p = .001). The estimated incidence rate of type 2 retear was 24% with SR (95% CI 14-38%), 43% with DR (95% CI 22-66%), 62% with SB (95% CI 54-70%) and 38% with SB (95% CI 23-57%).

Conclusion: Despite the lack of high-quality evidence, this study suggests that DR and SB techniques increase the risk of medial cuff failure. Modifications in surgical techniques in both DR and SB repairs can help decrease that risk.

Level of evidence: Level IV, systematic review of investigations including level IV.

Keywords: Medial cuff failure; Recurrent cuff tears; Retear patterns; Revision rotator cuff repair; Type 2 retears.

Publication types

  • Meta-Analysis
  • Systematic Review

MeSH terms

  • Arthroscopy
  • Humans
  • Recurrence
  • Risk Factors
  • Rotator Cuff Injuries / surgery*
  • Suture Techniques*