Functional Outcomes of Arthroscopic Double-Row Repair Using Single Anchors in Each Row for Massive Rotator Cuff Tears.

INTRODUCTION: Massive rotator cuff tears pose a significant surgical challenge due to severe tendon retraction and poor tissue quality. Standard multi-anchor double-row (DR) repairs offer strong biomechanical fixation in laboratories, but they significantly increase healthcare costs, risk anchor crowding, and deplete critical tuberosity bone stock. This raises the question of whether multi-anchor constructs are an absolute clinical necessity. MATERIALS AND METHODS: This retrospective cohort study evaluated the functional outcomes of a single-anchor DR (SADR) technique utilizing strictly one medial and one lateral anchor. Thirty-seven patients (n = 37) treated at Malabar Medical College Hospital and Research Centre between January 2021 and January 2023 were included. Outcomes included the American Shoulder and Elbow Surgeons (ASES) score, Constant-Murley score, Visual Analog Scale (VAS) for pain, and range of motion (ROM) assessed at baseline, 6, 12, and 24 months. Data were analyzed using paired t-tests and multivariate Cox proportional hazards regression. RESULTS: The cohort's mean age was 64.5 ± 6.5 years. ASES scores improved significantly from 38.5 ± 10.5 preoperatively to 82.0 ± 13.5 at 24 months (P < 0.001). Constant-Murley, VAS pain, and active ROM scores demonstrated parallel, significant improvements. Clinical survivorship at 24 months was 89.2%. Clinical failure was defined strictly as an ASES drop >20 points from the post-operative peak or the need for revision arthroplasty. Multivariate analysis identified older age (hazard ratios [HR] 1.07, P = 0.038) and higher pre-operative VAS (HR 1.22, P = 0.025) as independent predictors of failure. CONCLUSION: The SADR construct yields profound functional improvements at a minimum 2-year follow-up. This streamlined technique represents a highly viable, bone-preserving, and cost-effective alternative to multi-anchor repairs for massive tears.