This systematic review pooled 14 studies and 260 rotator cuff retears to compare retear patterns after single-row, double-row and suture bridge arthroscopic repair. It asks whether the more rigid double-row and suture bridge constructs shift the failure point from the tendon-bone interface (type 1) to the medial cuff (type 2). Retears were classified using the Cho system.
Double-row and suture bridge repairs win on biomechanics: better footprint coverage, higher load to failure, less gap formation. But this review shows that rigidity comes at a cost, pushing the failure point from the tendon-bone interface (type 1) to the medial cuff (type 2). That matters because type 2 retears are harder to revise. The tendon is now shorter and old implants sit at the footprint.
The mechanism is medial-row tension and contact pressure choking off tendon blood supply, creating zones of ischemia and necrosis medial to the anchors.
The practical lesson is in the modifications: fewer medial anchors, one suture each, no over-tensioning, suture placement at least 5 mm lateral to the musculotendinous junction, or absorbable sutures. Neyton dropped type 2 retears to 1 in 107 patients doing this. When you choose a stronger construct, protect the medial cuff or you may simply move the failure to a spot you cannot easily fix.
This systematic review pooled 14 studies and 260 rotator cuff retears to compare retear patterns after single-row, double-row and suture bridge arthroscopic repair. It asks whether the more rigid double-row and suture bridge constructs shift the failure point from the tendon-bone interface (type 1) to the medial cuff (type 2). Retears were classified using the Cho system.
Double-row and suture bridge repairs win on biomechanics: better footprint coverage, higher load to failure, less gap formation. But this review shows that rigidity comes at a cost, pushing the failure point from the tendon-bone interface (type 1) to the medial cuff (type 2). That matters because type 2 retears are harder to revise. The tendon is now shorter and old implants sit at the footprint.
The mechanism is medial-row tension and contact pressure choking off tendon blood supply, creating zones of ischemia and necrosis medial to the anchors.
The practical lesson is in the modifications: fewer medial anchors, one suture each, no over-tensioning, suture placement at least 5 mm lateral to the musculotendinous junction, or absorbable sutures. Neyton dropped type 2 retears to 1 in 107 patients doing this. When you choose a stronger construct, protect the medial cuff or you may simply move the failure to a spot you cannot easily fix.