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BACKGROUND There is growing interest in using suture-buttons for coracoid fixation to avoid the complications associated with screws during the Latarjet procedure. However, achieving bone block healing is critical for successful shoulder stabilization and return to sport. PURPOSE To assess and compare the healing rates and positioning of the coracoid bone block fixed with cortical suture-buttons that were either manually (using a knot pusher) or mechanically tensioned (using a tensioning device) during arthroscopic Latarjet procedures. METHODS Prospective, non-randomized, comparative study enrolling 69 consecutive patients (mean age, 27 years) who underwent an arthroscopic guided Latarjet with suture-button fixation. Hand-tensioning (group HT) was performed in the first 34 shoulders and the next 35 shoulders had mechanical-tensioning (group MT). Twelve patients (17%) had a history of previous failed Bankart stabilization. The characteristics of the patients for age, gender, type of sports, bone loss, number of previous failed surgery, smoking and length of follow-up in each group were comparable. Intraoperatively, the tensioning device was set at 100 Newtons successively 3 times until complete immobilization of the bone block assessed with a probe. The primary outcome measure was coracoid bone block union and position on CT-scan images at 6 months follow-up. Secondary outcome measures included functional outcome scores, shoulder stability, return to sports, and complications at last follow-up. RESULTS Overall, the rate of bone block healing was 74% (25/34) in group HT and 94% (33/35) in group MT (p = 0.043). Smoking was an independent risk factor associated with non-union (P<.001) in each group. Patient age, size of the preoperative glenoid bone defect (<20% or >20%), and a history of previous surgery were not found to have any influence. Tensioning modality did not affect the bone block position which was subequatorial in 92% of the cases of the cases and flush to the glenoid rim in 92%. At a mean of 34 months (range, 24-62 months), 96% of the patients (65/69) had a stable shoulder, and 87 % returned to sports. At final follow-up, no significant difference in clinical scores was noted between the groups; no neurologic or hardware complications were observed. CONCLUSION Mechanical-tensioning achieves significantly higher healing rates than hand-tensioning during arthroscopic Latarjet procedure with suture-button fixation. The use of a suture-tensioning device is a key step to the suture-button fixation technique during arthroscopic Latarjet procedures. By rigidifying the suture-button construct, the tensioning device transforms the initially flexible suture into a "rigid fixation", similar to a bolt (or a rivet).