This Level I RCT compares tendon healing after single-row versus double-row suture bridge (transosseous equivalent) arthroscopic repair of isolated supraspinatus tears. A single surgeon repaired 90 shoulders, all with tears under 25 mm, and assessed healing by serial ultrasound out to one year. Healing rate, not clinical outcome, was the chosen endpoint.
The clinical question here is narrow but important: does double-row fixation actually make the tendon heal better, or just look stronger on the bench? This RCT answers the structural half of that question. For small isolated supraspinatus tears, suture bridge fixation healed 93% of the time versus 75% for single-row.
The critical caveat is the endpoint. The authors chose healing rate on purpose, reasoning that a costlier, more technically demanding operation must first prove superior healing before clinical outcome studies are worth doing.
Remember the broader literature they cite: most trials show no difference in patient-reported outcomes for tears under 3 cm, with a possible clinical advantage only for tears over 3 cm. So the mental model is this. Double-row heals better structurally, but a healed tendon on ultrasound does not guarantee a better-functioning shoulder, and cost and operative time go up.
This Level I RCT compares tendon healing after single-row versus double-row suture bridge (transosseous equivalent) arthroscopic repair of isolated supraspinatus tears. A single surgeon repaired 90 shoulders, all with tears under 25 mm, and assessed healing by serial ultrasound out to one year. Healing rate, not clinical outcome, was the chosen endpoint.
The clinical question here is narrow but important: does double-row fixation actually make the tendon heal better, or just look stronger on the bench? This RCT answers the structural half of that question. For small isolated supraspinatus tears, suture bridge fixation healed 93% of the time versus 75% for single-row.
The critical caveat is the endpoint. The authors chose healing rate on purpose, reasoning that a costlier, more technically demanding operation must first prove superior healing before clinical outcome studies are worth doing.
Remember the broader literature they cite: most trials show no difference in patient-reported outcomes for tears under 3 cm, with a possible clinical advantage only for tears over 3 cm. So the mental model is this. Double-row heals better structurally, but a healed tendon on ultrasound does not guarantee a better-functioning shoulder, and cost and operative time go up.