When the surprise is revealed at the end of David Fincher’s The Game, Michael Douglas’s character is reminded that he was drugged and left for dead in Mexico and all that he got was a lousy t-shirt (and a gigantic bill I might add). John Kramer aka Jigsaw (Tobin Bell) can relate in Saw X. And while he doesn’t get a t-shirt, he definitely gets some new games to engineer after his visit to our southern neighbor.

As many franchises do nowadays, this tenth installment of the nearly two decade old series doesn’t require knowledge of the entire canon. You really only need to remember Saw (2004) and its 2005 sequel (they remain the best two of the bunch). To jar those memories, Bell’s Kramer has terminal brain cancer. His civil engineering background allows him to concoct elaborate traps for victims. He doesn’t look at them that way because they’re generally terrible people who’ve wronged him or others. The patient known as Jigsaw doesn’t actually kill them as he gives them opportunities for escape and I suppose personal growth. As we’ve witnessed in nine pictures already, these candidates for redemption frequently fail their tests. One of Jigsaw’s would-be cases is Amanda (Shawnee Smith). She passed her exam back in the original and was revealed to be his apprentice in part II.

With those friendly reminders, Saw X takes place between the happenings of Saw and Saw II. John is freshly diagnosed and given months to live. An acquaintance from a cancer support group tips him to experimental therapy in Mexico run by Norwegian doctor Cecelia Pederson (Synnøve Macody Lund). The eventual surgery yields puzzling results and Jigsaw realizes that the Scandinavian surgeon and her conspirators need his unique form of tutelage. Let the games begin.

Among the flaws of many Saw entries after the second and third ones is they fell all over themselves trying to feature Bell’s Jigsaw in them (or at least his aura). Two of them (Saw VI, Saw 3D) were directed by Kevin Greutert and he returns here. I can understand the strained Jigsaw inclusions as he’s the most compelling character and other villains (or sadistic heroes depending on how you look at it) didn’t match up. Therefore it’s a relief that screenwriters Josh Stolberg and Peter Goldfinger (who penned the inferior immediate predecessor Spiral) find a clever way to make him the star. These movies are dimly lit so the fact that Bell and Smith have aged a few years isn’t much of a distraction. The script also gives Bell the most screen time he’s probably ever had. That’s a plus. Yet Saw X is also quite leisurely paced at two hours. Stretching a Saw saga beyond 90 to 100 minutes is a test of endurance.

Stolberg and Goldfinger were also responsible for Jigsaw in 2017. I found it to be a mostly effective reboot. Saw X is similar in quality. Like Jigsaw, it ebbs somewhat in the third act. It takes a little too long to get where it’s going. We know John and Amanda will set their barbarous traps and that’s delivered occasionally in peak Saw fashion. The straightforward story is far less convoluted than other sequels with their overreliance on flashbacks to bring Bell into the proceedings.

Bell is front and center in this for good reason. He’s got loads of intestinal fortitude to carry forth his mission. So do his captors at one point… you’ll see. This is the tenth pic arriving 19 years after we first met the patient. It belongs in the top half in the rankings and I would diagnose it as a cut above everything after the third one (with the possible exception of Jigsaw).