Narrative review tracing the evolution of suture anchors in arthroscopic rotator cuff repair from transosseous tunnels through single-row, double-row, and suture-bridging constructs. Describes the biomechanical rationale for each generation and outlines the authors' preferred techniques for varying tissue quality.
Choosing the right anchor construct is not a brand preference — it is a biomechanical decision that directly affects healing. For standard cases with adequate tendon mobility, suture-bridging (linked medial and lateral rows) is the construct of choice: it self-reinforces under load and achieves healing rates of 84-92% across tear sizes.
When tissue is poor or tendon is short, shift to the load-sharing rip-stop. It delivers 616 N mean load to failure and moves the failure point to the anchor. Protecting the tendon when you cannot improve it.
In osteoporotic bone, always use a fully threaded screw-in anchor for lateral knotless fixation. Push-in anchors may pass ultimate load testing but gap under cyclic load. Which is the failure mode that matters clinically. All-soft suture anchors are contraindicated for cuff repair based on current biomechanical data.
Narrative review tracing the evolution of suture anchors in arthroscopic rotator cuff repair from transosseous tunnels through single-row, double-row, and suture-bridging constructs. Describes the biomechanical rationale for each generation and outlines the authors' preferred techniques for varying tissue quality.
Choosing the right anchor construct is not a brand preference — it is a biomechanical decision that directly affects healing. For standard cases with adequate tendon mobility, suture-bridging (linked medial and lateral rows) is the construct of choice: it self-reinforces under load and achieves healing rates of 84-92% across tear sizes.
When tissue is poor or tendon is short, shift to the load-sharing rip-stop. It delivers 616 N mean load to failure and moves the failure point to the anchor. Protecting the tendon when you cannot improve it.
In osteoporotic bone, always use a fully threaded screw-in anchor for lateral knotless fixation. Push-in anchors may pass ultimate load testing but gap under cyclic load. Which is the failure mode that matters clinically. All-soft suture anchors are contraindicated for cuff repair based on current biomechanical data.