Editorial Commentary: Does a Medialized Repair Allow Single-Row to Outperform Double-Row Rotator Cuff Repair?

The optimal surgical technique for arthroscopic rotator cuff repair remains controversial, with advantages and disadvantages to each of the most commonly used methods. The pattern as well as number of suture anchors relative to the footprint has been one of the most common sources of debate, with proponents and arguments for both single- and double-row arrangements. Although double-row techniques have been shown to be biomechanically superior and to improve footprint coverage, evidence has been mixed as to whether they are clinically superior, especially in small- and medium-sized tears. Whereas historically, single-row repairs have aimed to restore pre-tear tendon tension, there recently has been interest in a medialized single-row technique to reduce repair tension. Advantages of this technique include a reduced number of anchors and thus a reduced cost, an efficient technique, and a potential reduction in tension, which could improve healing rates. Disadvantages of this technique include a reduced tendon-to-bone area of contact, which may lead to higher rates of incomplete healing.