Arthroscopic Transtendinous Modified Double-Row Suture Bridge Repair of a Bony PASTA Lesion

Abstract

Surgical and conservative management of partial tears of the rotator cuff has long been a controversial topic for many generations of shoulder surgeons. These tears frequently occur on both the articular and bursal surfaces and within the intrasubstance of the rotator cuff. The term "PASTA lesion" describes the partial articular supraspinatus tendon avulsion-type injury. A less common variant of this injury is the bony PASTA lesion or partial articular bony avulsion of the supraspinatus tendon (PABAST).

Fig 1

Anterior view of shoulder joint showing arthroscopic setup along with partially avulsed supraspinatus tendon and bony fragment from greater tuberosity.

Fig 2

Anterior and superior oblique views of shoulder joint showing 2 suture anchors placed percutaneously through supraspinatus within greater tuberosity.

Fig 3

Anterior and superior oblique views of shoulder joint showing 2 sutures tied in horizontal mattress configuration with free suture ends left long.

Fig 4

Anterior and superior oblique views of shoulder joint showing 2 suture anchors with free ends of sutures being incorporated into push-in anchor inserted into lateral cortex of greater tuberosity.