Randomized trial comparing two bridging suture tensions in transosseous-equivalent rotator cuff repair for medium- to large-sized tears. One group used optimum tension (~96 N, from a prior cadaver study), the other used maximum tension (~199 N). It asks whether higher bridging tension changes healing and functional outcomes.
The teaching point is that time-zero cadaveric biomechanics does not always predict healing in a living tendon. The cadaver study said tension above 90 N buys nothing; the clinical trial found the opposite for anatomic healing.
The authors explain the gap: healing depends on sustained footprint contact pressure, tension relaxes as you seat the second lateral anchor and during rehab, and tendon blood supply recovers over time. The long-standing worry that high bridging tension strangles the medial row and drives type II failure was not borne out here, with just one type II failure in the maximum tension group.
One caveat for the exam and the clinic: at 2 years, healed and failed tendons had similar clinical scores, so the benefit shown is anatomic. There is still no intraoperative device to measure bridging tension in routine practice, so this cannot be dialed in precisely at the moment.
Randomized trial comparing two bridging suture tensions in transosseous-equivalent rotator cuff repair for medium- to large-sized tears. One group used optimum tension (~96 N, from a prior cadaver study), the other used maximum tension (~199 N). It asks whether higher bridging tension changes healing and functional outcomes.
The teaching point is that time-zero cadaveric biomechanics does not always predict healing in a living tendon. The cadaver study said tension above 90 N buys nothing; the clinical trial found the opposite for anatomic healing.
The authors explain the gap: healing depends on sustained footprint contact pressure, tension relaxes as you seat the second lateral anchor and during rehab, and tendon blood supply recovers over time. The long-standing worry that high bridging tension strangles the medial row and drives type II failure was not borne out here, with just one type II failure in the maximum tension group.
One caveat for the exam and the clinic: at 2 years, healed and failed tendons had similar clinical scores, so the benefit shown is anatomic. There is still no intraoperative device to measure bridging tension in routine practice, so this cannot be dialed in precisely at the moment.