This prospective study followed 342 suture-anchor rotator cuff repairs by a single surgeon. It asked one question: when these repairs fail, where mechanically do they fail? Mode of failure was recorded systematically at revision surgery and compared with the original repair.
The clinical lesson is where to focus your repair strength: the tendon, not the bone. For years the concern was that suture anchors would pull out of osteoporotic proximal humerus. This paper shows that fear is largely misplaced.
When a suture-anchor mattress repair fails, the tendon cuts through the sutures while the anchor stays put. That reframes the technical problem toward improving tendon-side fixation.
Practically, this supports using more anchors, more suture limbs, and tendon-grasping stitch configurations that resist pull-through. It is part of the mechanical rationale behind later moves toward more secure suture patterns and double-row constructs.
One caveat worth carrying to boards: revision patients are a biased sample, since many mechanically failed repairs stay asymptomatic and never get re-explored.
This prospective study followed 342 suture-anchor rotator cuff repairs by a single surgeon. It asked one question: when these repairs fail, where mechanically do they fail? Mode of failure was recorded systematically at revision surgery and compared with the original repair.
The clinical lesson is where to focus your repair strength: the tendon, not the bone. For years the concern was that suture anchors would pull out of osteoporotic proximal humerus. This paper shows that fear is largely misplaced.
When a suture-anchor mattress repair fails, the tendon cuts through the sutures while the anchor stays put. That reframes the technical problem toward improving tendon-side fixation.
Practically, this supports using more anchors, more suture limbs, and tendon-grasping stitch configurations that resist pull-through. It is part of the mechanical rationale behind later moves toward more secure suture patterns and double-row constructs.
One caveat worth carrying to boards: revision patients are a biased sample, since many mechanically failed repairs stay asymptomatic and never get re-explored.