Editorial Commentary: Don't Pull Too Hard: Decreasing Tension in Rotator Cuff Repairs, Especially for Large and Retracted Tears, Leads to Superior Outcomes and Healing Rates.

Among the strategies to improve outcomes of rotator cuff repair, proper surgical technique is quintessential. While the ideal goal of a rotator cuff repair is anatomic restoration of the native tendon footprint, this may not always be possible to accomplish without placing significant tension on the medial stump. Recent literature shows the importance of tension modulation in rotator cuff repair, showing better clinical outcomes and healing rates with tension-reducing techniques, compared with full footprint covering repair, with the difference notable in larger and more retracted tears. Simultaneously single- and double-row repairs showed similar outcomes, better results were achieved with rehabilitation that was conservative rather than accelerated, and no difference was shown between tendon remnant preservation and footprint medialization.