• Double-Row Solutions
• Double-Row Benefits
• Double-Row Procedures
• Clinical References

The Biology of Double-Row Repair

Repair biology is a key to improving rotator cuff repair outcomes. This includes not only biomechanical considerations such as stiffness, gap formation, and load to failure, but also biological factors as illustrated in the following videos:

• Maximizing the amount of the native tendon footprint that is available for reattachment
  Watch video


• Precise placement of the tendon to its native insertion footprint
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• Controlled suture tension that spreads pressure over cuff with no stress concentrations
  Watch video


• Channeling blood to the repair site
  Watch video

Optimizing Double-Row Products

Achieving an ideal double-row repair requires optimized medical devices, surgical instruments, and operative techniques in every aspect of the procedure. Optimized solutions for double-row repair procedures are summarized below and illustrated in the accompanying videos.

The optimal medial-row anchor:

• Small diameter/volume to preserve maximum healing footprint
• Strong bone lock for repair security
• Cannulated or hollow to channel blood
• Fast, easy to use

The optimal lateral-row anchor:

• Strong bone lock and suture lock for repair security
• Cannulated or hollow to channel blood
• Ability to control suture tension to evenly distribute contact pressure over tendon footprint
• Fast, easy, reliable
• Knotless to remove arthroscopic knot-tying variability and difficulty

The optimal suture passing system:

• Minimum amount of steps
• Easy suture management
• Fewest and smallest cuff perforations
• Fast, simple, reliable
  

Optimizing Patient Selection

Certain patient populations have a greater disposition to benefit from double-row repair constructs than others. The following considerations are important when recommending double-row repair:

• Tear size: While the benefits of double row are less demonstrable for small to medium size tears, the benefits for large and massive tears have been shown ¹⁷
• Patient Compliance: If there is reason to suspect that a patient will not be compliant with the rehab protocol, a double-row repair might provide extra repair security.
• Bone and tendon quality of the patient
• Occupation / activity level of patient: If a patient’s occupation or lifestyle requires lifting or frequent or strenuous use of the shoulder, or if they are an overhead athlete, double-row repair could allow for improved biomechanical strength to allow quicker return to activities.