Comparison of modified single-row enhanced repair and double-row suture bridge repair rotator cuff tears

doi:10.3877/cma.j.issn.1674-134X.2026.04.002

Abstract

Abstract:

Objective

To observe and compare the clinical efficacy differences between the modified single-row enhanced technique (sunglasses loop) repair and the traditional double-row suture bridge repair in the treatment of medium-sized rotator cuff tears, and to provide theoretical basis and technical support for optimizing the rotator cuff repair plan.

Methods

Inclusion criteria: preoperative MRI-confirmed supraspinatus tear of three to five centimetres, failed conservative treatment, repairable tendon, and follow-up at least 12 months. Exclusion criteria: previous ipsilateral shoulder surgery, infection, severe arthritis, irreparable defect, etc. According to the inclusion and exclusion criteria, a total of 116 patients with moderate rotator cuff tears who underwent arthroscopic rotator cuff repair in Zhuhai People’s Hospital from May 2022 to May 2024 were selected and divided into the sunglasses loop group (n=61) and the double-row suture bridge group (n=55) according to the surgical methods. All the patients in both groups had MRI examinations before the operation to confirm supraspinatus tendon tears, with the tear range beingthree to five centimeters, and all were unilateral lesions. The observation indicators included the operation time during the surgery, the Constant-Murley shoulder function score and visual analogue scale (VAS) before the operation and at one, three, six and 12 months after the operation, as well as the MRI assessment of healing at 12 months after the operation. Continuous variables comparison performed by independent t test, categorical variables analysis used chi square test.

Results

Both groups showed significant improvement in Constant and VAS scores postoperatively (paired t test, P<0.05). The sunglasses loop group had significantly higher Constant scores at three, six and 12 months than the double-row suture bridge group (t=3.39, 2.69, 2.86, all P<0.01), and significantly lower VAS scores (t=-2.48, -2.63, -2.80, all P<0.05). Operation time was significantly shorter in the sunglasses loop group (t=-10.14, P<0.001). Postoperative MRI showed a complete healing rate of 88.5% in the sunglasses loop group, which was superior to 76.4% in the double-row suture bridge group.

Conclusions

For medium-sized rotator cuff tears, the modified single-row enhanced technique (sunglasses loop) shows shorter operation time, better mid-term functional and pain scores, and a higher imaging-documented healing rate compared to the traditional double-row suture bridge repair, it may provide an effective alternative in clinical practice. This conclusion is derived from a retrospective analysis and warrant further validation through well-designed prospective, randomized controlled studies to confirm its efficacy and superiority.

Key words: Rotator cuff injuries, Suture techniques, Orthopedic procedures, Arthroscopy, Treatment outcome

Yang Xiang, Jianfeng Ouyang, Bingquan Li, Yongheng Ye. Comparison of modified single-row enhanced repair and double-row suture bridge repair rotator cuff tears[J]. Chinese Journal of Joint Surgery(Electronic Edition), 2026, 20(04): 406-415.

/ / Recommend

Add to citation manager EndNote|Ris|BibTeX

URL: https://zhgjwkzz.cma-cmc.com.cn/EN/10.3877/cma.j.issn.1674-134X.2026.04.002

https://zhgjwkzz.cma-cmc.com.cn/EN/Y2026/V20/I04/406

Figures/Tables 13

Figure 1 Illustration and arthroscopic image of first tendon passage of the sunglasses loop technique. A is the first tendon passage illustration of right shoulder; B is the arthroscopic visualization of the right shoulder (viewing from the lateral subacromial portal) Note: patient lies in the lateral decubitus position while the Orthocord suture firstly passed through the articular side to the bursal side using a suture passer shuttling device

Figure 2 Illustration and arthroscopic image of the second tendon passage tendon passage of sunglasses loop technique. A is tendon passage illustration of right shoulder; B is the arthroscopic visualization of the right shoulder (viewing from the lateral subacromial portal) Note: patient lies in the lateral decubitus position, the other end of the suture is passed through the rotator cuff tissue one centimetre away from the exit of the first stitch at the bursa-articular side, creating a thread loop on the bursa side of the rotator cuff

Figure 3 Illustration and arthroscopic image of the third tendon passage of the sunglasses loop technique. A is tendon passage illustration of right shoulder; B is the arthroscopic visualization of the right shoulder (viewing from the lateral subacromial portal) Note: patient lies in the lateral decubitus position, the suture end is passed back from the articular side of the rotator cuff to the thread loop at the exit of the third stitch on the bursa side of the rotator cuff

Figure 4 Illustration and arthroscopic image of the fourth tendon passage of the sunglasses loop technique. A is tendon passage illustration of right shoulder; B is the arthroscopic visualization of the right shoulder (viewing from the lateral subacromial portal) Note: patient lies in the lateral decubitus position，the other end of the suture passes from the thread loop at hte exit of the first stitch on the joint-bursa side, completing the modified suture to form the sunglasses loop which acts as a rip-stop

Figure 5 Illustration and arthroscopic image of the single row with triple-loaded suture anchor. A is tendon passage illustration of right shoulder; B is the arthroscopic visualization of the right shoulder (viewing from the lateral subacromial portal)

Figure 6 Final configuration of sunglasses loop enhancement technique repair. A is tendon passage illustration of right shoulder; B is the arthroscopic visualization of the right shoulder (viewing from the lateral subacromial portal)

Table 1 Comparison of preoperative baseline characteristics between the two groups

组别 Groups	例数 Number of cases	年龄［岁，（ $x ¯$ ±s）］ Age（year）	性别（男/女） Gender（male/female）	患侧（左/右） Affected side（left/right）	病程［月，（ $x ¯$ ±s）］ Disease duration（months）
改良单排组 Sunglasses loop group	61	52.3±8.1	34/27	28/33	8.2±3.5
双排缝线桥组 Suture Bridge group	55	53.1±7.9	30/25	24/31	8.6±3.8
统计值 Statistical values		t =-0.536	χ²=0.042	χ²=0.062	t =-0.586
P值		＞0.05	＞0.05	＞0.05	＞0.05

Table 1 Comparison of preoperative baseline characteristics between the two groups

组别 Groups	例数 Number of cases	年龄［岁，（ $x ¯$ ±s）］ Age（year）	性别（男/女） Gender（male/female）	患侧（左/右） Affected side（left/right）	病程［月，（ $x ¯$ ±s）］ Disease duration（months）
改良单排组 Sunglasses loop group	61	52.3±8.1	34/27	28/33	8.2±3.5
双排缝线桥组 Suture Bridge group	55	53.1±7.9	30/25	24/31	8.6±3.8
统计值 Statistical values		t =-0.536	χ²=0.042	χ²=0.062	t =-0.586
P值		＞0.05	＞0.05	＞0.05	＞0.05

Table 2 Comparison of MRI Goutallier fatty infiltration grades between the two groups

分组 Groups	例数 Number of cases	轻度退变 Mild degeneration	中度退变 Moderate degeneration	重度退变 Severe degeneration
改良单排组 Sunglasses loop group	61	34（55.7）	21（34.4）	6（9.8）
双排缝线桥组 Suture bridge group	55	33（60.0）	18（32.7）	4（7.3）
χ²值		0.38
P值		＞0.05

Table 3 Comparison of Constant-Murley scores between the two groups at different time points

分组 Groups	例数 Number of cases	术前 Before surgery	术后1个月 One month after surgery	术后3个月 Three months after surgery	术后6个月 Six months after surgery	术后12个月 12 months after surgery
改良单排组Sunglasses loop group	61	49±6	65±6	78±5	86±5	91±4
双排缝线桥组 Suture bridge group	55	48±6	64±5	75±5	82±5	87±4
t值		0.90	0.97	3.38	2.69	2.86
P值		＞0.05	＞0.05	＜0.01	＜0.01	＜0.01

Table 4 Comparison of VAS scores between the two groups

分组 Groups	例数 Number of cases	术前 Before surgery	术后1个月 One month after surgery	术后3个月 Three months after surgery	术后6个月 Six months after surgery	术后12个月 12 months after surgery
改良单排组Sunglasses loop group	61	6.8±1.0	3.9±0.8	2.3±0.6	1.4±0.5	0.8±0.4
双排缝线桥组 Suture bridge group	55	6.9±0.9	4.0±0.9	2.7±0.7	1.8±0.6	1.2±0.5
t值				-2.48	-2.63	-2.80
P值		＞0.05	＞0.05	＜0.05	＜0.01	＜0.01

Figure 7 MRI images of right shoulder at coronal view before and after repair with the sunglasses loop technique. A is MRI before surgery, showing a supraspinatus tendon tear; B and C are MRI images three and six months after repairing, showing a stable tendon suture area; D is MRI 12 months after repairing, showing the tendon healing well with continuous suture area

Figure 8 Comparison of MRI features of postoperative re-tears between two repair techniques. A is MRI at one-year follow-up after double-row suture repair showing a tear at the musculotendinous junction of the supraspinatus; B is MRI at one-year follow-up after the sunglasses loop technique showing a typical partial tear at the medial aspect of the supraspinatus footprint

Table 5 Comparison of the number of suture anchors used and material costs between the two groups

分组 Groups	例数 Number of cases	锚钉数量（个） Number of anchors（piece）	锚钉费用（千元） Anchor cost（thousand yuan）
改良单排组 Sunglasses Loop group	61	2.4±0.6	12.0±3.0
双排缝线桥组 Suture bridge group	55	4.3±0.5	21.5±2.5
t值		-19.53	-18.19
P值		P＜0.001	P＜0.001

References 21

［1］	张伟, 孙争争, 张波, 等. 三维CT重建下肩峰形态参数与肩袖撕裂之间的相关性研究［J］. 齐齐哈尔医学院学报, 2025, 46（14）: 1366－1371.
［2］	Doiron-Cadrin P, Lafrance S, Saulnier M, et al. Shoulder rotator cuff disorders: a systematic review of clinical practice guidelines and semantic analyses of recommendations［J］. Arch Phys Med Rehabil, 2020, 101（7）: 1233－1242.
［3］	赵第, 韩燕鸿, 潘建科, 等. 不同类型肩袖损伤最佳治疗策略的选择及探讨［J］. 中国组织工程研究, 2020, 24（18）: 2911－2918.
［4］	韩庆欣, 张磊, 张晟, 等. 关节镜下缝线桥技术治疗肩袖损伤5年以上临床随访结果: 术后再撕裂率及再撕裂对肩关节功能的影响［J］. 中国运动医学杂志, 2021, 40（6）: 427－432.
［5］	Werner BC, Chang B, Nguyen JT, et al. What change in American shoulder and elbow surgeons score represents a clinically important change after shoulder arthroplasty?［J］. Clin Orthop Relat Res, 2016, 474（12）: 2672－2681.
［6］	Toussaint B, Schnaser E, Lafosse L, et al. A new approach to improving the tissue grip of the medial-row repair in the suture-bridge technique: the “modified lasso-loop stitch”［J］. Arthroscopy, 2009, 25（6）: 691－695.
［7］	骆勇刚, 陈俊, 庄万强, 等. 肩关节镜下不同缝合固定修复技术治疗肩袖损伤的临床疗效［J］. 局解手术学杂志, 2021, 30（6）: 535－540.
［8］	Yamakado K, Katsuo SI, Mizuno K, et al. Medial-row failure after arthroscopic double-row rotator cuff repair［J］. Arthroscopy, 2010, 26（3）: 430－435.
［9］	OuYang J, Xiao X, Li B, et al. A modified Mason-Allen suture enhancement technique （sunglasses loop） for single-row repair of medium-to-large rotator cuffs［J/OL］. Arthrosc Tech, 2024, 13（7）: 103007. DOI: 10.1016/j.eats.2024.103007.
［10］	史加奎, 唐志强, 徐思君, 等. 关节镜下双排缝合联合无结缝线桥技术治疗中大型肩袖撕裂的临床研究［J］. 中国内镜杂志, 2025, 31（2）: 16－24.
［11］	孔耀, 王翠苹, 聂志奎, 等. 镜下双锁定中国结与传统双排修复肩袖损伤的比较［J］. 中国矫形外科杂志, 2025, 33（13）: 1178－1184.
［12］	Park MC, ElAttrache NS, Tibone JE, et al. Part I: Footprint contact characteristics for a transosseous-equivalent rotator cuff repair technique compared with a double-row repair technique［J］. J Shoulder Elbow Surg, 2007, 16（4）: 461－468.
［13］	Khoriati AA, Antonios T, Gulihar A, et al. Single Vs Double row repair in rotator cuff tears-A review and analysis of current evidence［J］. J Clin Orthop Trauma, 2019, 10（2）: 236－240.
［14］	Vecchini E, Ricci M, Elena N, et al. Rotator cuff repair with single row technique provides satisfying clinical results despite consistent MRI retear rate［J/OL］. J Orthop Traumatol, 2022, 23（1）: 23. DOI: 10.1186/s10195－022-00642-x.
［15］	Cho NS, Yi JW, Lee BG, et al. Retear patterns after arthroscopic rotator cuff repair: single-row versus suture bridge technique［J］. Am J Sports Med, 2010, 38（4）: 664－671.
［16］	Disegni E, Housset V, Nourissat G. The mason-loop for single-row full-thickness rotator cuff repair［J/OL］. Arthrosc Tech, 2024, 13（12）: 103145. DOI: 10.1016/j.eats.2024.103145.
［17］	Mori D, Kizaki K, Funakoshi N, et al. Clinical and radiographic outcomes after arthroscopic lamina-specific double-row repair of large delaminated rotator cuff tears in active patients［J/OL］. Orthop J Sports Med, 2019, 7（4）: 2325967119838249. DOI: 10.1177/2325967119838249.
［18］	Zheng J, Xiao Q, Deng H, et al. The Chinese knot stitch technique using a footprint ultrasuture anchor for rotator cuff repair［J/OL］. Arthrosc Tech, 2020, 9（3）: e321－e326. DOI: 10.1016/j.eats.2019.10.012.
［19］	Xiao Q, Quan X, Hu S, et al. A comparison between knotted and knotless medial row of suture bridge technique in arthroscopic rotator cuff repair surgery: a meta-analysis［J/OL］. J Orthop Surg Res, 2023, 18（1）: 338. DOI: 10.1186/s13018－023－03812－7.
［20］	Huang Q, Li X, Zhang Y, et al. Comparison of clinical outcomes of arthroscopic rotator cuff repair utilizing suture-bridge procedures with or without medial knots: a meta-analysis［J/OL］. BMC Surg, 2023, 23（1）: 158. DOI: 10.1186/s12893－023－02060－0.
［21］	Cobaleda Aristizabal AF, Barber FA. Rotator cuff repair: technical considerations influencing optimum anchor choice in rotator cuff repair［J/OL］. Ann Joint, 2021, 6: 18. DOI: 10.21037/aoj－20－32.

[1]	Deyu Wang, Fumin Xue, Wei Wei, Xuefeng Guan. Mechanisms of platelet-rich plasma in promoting articular cartilage repair and advances in its adjunctive use in arthroscopy [J]. Chinese Journal of Joint Surgery(Electronic Edition), 2026, 20(03): 344-352.
[2]	Hang Ji, Hailong Luan, Yushu Chen, Yu Wang. Posterolateral bundle repair surgery of anterior cruciate ligament for mild anterior knee instability [J]. Chinese Journal of Joint Surgery(Electronic Edition), 2026, 20(03): 381-386.
[3]	Joint Surgery Group of the Orthopedic Society of the Chinese Medical Association. Expert consensus on application of intelligent sensor-based dynamic guidance technology in orthopedic surgery (2026 version) [J]. Chinese Journal of Joint Surgery(Electronic Edition), 2026, 20(02): 131-140.
[4]	Weijin Miao, Jie Xie, Min Wang, Xiaofei Liu, Shaohua Liang, Menghu Han, Xianmao Liu, Wen Wang. Comparison of artificial dermis and acellular allogeneic dermis for rotator cuff repair [J]. Chinese Journal of Joint Surgery(Electronic Edition), 2026, 20(02): 151-157.
[5]	Rui Lin, Wenzhao Chen, Jiaying Liu, Xiangyu Long. Study on efficacy and mechanism of Taohong Siwu decoction in treatment of knee osteoarthritis [J]. Chinese Journal of Joint Surgery(Electronic Edition), 2026, 20(02): 206-214.
[6]	Yaoting Wang, Mingxin Wang, Long Wang, Xiaoqi Kang, Chunbao Li. Mechanical study on perineal post-free traction technique in Trendelenburg position [J]. Chinese Journal of Joint Surgery(Electronic Edition), 2026, 20(02): 215-221.
[7]	Jin Zhang, Min Wang, She Jia, Longhui Shao, Weiyu Yang. Total internal suture using rotator cuff suture hook under arthroscope for meniscus injury [J]. Chinese Journal of Joint Surgery(Electronic Edition), 2026, 20(02): 248-251.
[8]	Ya Xu, Xiang Wang, Gaopeng Liu, Yuru Huang, Bin Wang. Arthroscopic suspension fixation without coracoid bone tunnel for acute acromioclavicular joint dislocation [J]. Chinese Journal of Joint Surgery(Electronic Edition), 2026, 20(01): 104-109.
[9]	Xiaoling Liu, Xiaoxi Xie, Xiao Li, Chunhui Wang. Diagnosis and treatment value of endoscopic retrograde cholangiopancreatography in children with pancreaticobiliary disease [J]. Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition), 2026, 22(03): 229-238.
[10]	Guangxin Li, Huijuan Quan, Zhijuan Gao, Liang Li, Xiaojun Wang, Yuqing Cao. Comparison of the clinical effects of emergency laparoscopic resection and stent placement with delayed resection in the treatment of obstructive colorectal cancer [J]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2026, 20(02): 142-145.
[11]	Xiaomou He, Hui Luo, Jinbao Ma, Fei Ren, Rong Yuan, Jianying Li, Liyun Dang, Yanfei Wang. Applicability of three nutritional risk screening tools for 350 in-hospital patients with multidrug-resistant pulmonary tuberculosis based on GLIM criteria [J]. Chinese Journal of Lung Diseases(Electronic Edition), 2026, 19(03): 451-458.
[12]	Pengfei Li, Zihao Huang, Ketao Wang, Feng Qu. Arthroscopic resection and debridement for sinus tarsi syndrome with too-long anterior process of the calcaneus: short-term results [J]. Chinese Journal of Laparoscopic Surgery(Electronic Edition), 2026, 19(03): 165-170.
[13]	Yunchen Wang, Xiaozhong Ma, Wenming Jiang, Heng Zhu, Hao Shu. Observation on the clinical efficacy of arthroscopic transposition and strengthening of the long head tendon of the biceps brachii combined with partial rotator cuff repair in the treatment of massive and irreparable rotator cuff tears [J]. Chinese Journal of Shoulder and Elbow(Electronic Edition), 2026, 14(01): 12-20.
[14]	Yuanzhi Li, Zhijie Dong, Yibo Wang, Lei Xie, Shuai He, Dong Xing. Knee joint function and sports performance following anterior cruciate ligament reconstruction using different grafts: a comparative study [J]. Chinese Journal of Clinicians(Electronic Edition), 2026, 20(02): 106-113.
[15]	Jie Sun, Liang Yang, Chunyan Huang, Yuntao Shi, Yao Liu. Different Interventional Embolization Approaches for Splenic Artery Aneurysms: A Retrospective Clinical Study [J]. Chinese Journal of Interventional Radiology(Electronic Edition), 2026, 14(03): 272-277.

Please choose a citation manager

Content to export