Repairing PASTA Lesions Without Violation of the Rotator Cuff

Abstract

Partial-thickness articular-sided rotator cuff tears are a common cause of shoulder pain in adults. Although partial rotator cuff tears have a high prevalence, there is still controversy over their proper surgical treatment. Different surgical procedures have been suggested when partial tears involve the articular side of the rotator cuff, such as arthroscopic debridement of the tear with or without acromioplasty, tear completion and repair, and transtendinous in situ repair. Although multiple repair techniques have been described, significant clinical data to definitively support one technique over the others are currently lacking. We describe an arthroscopic technique for repair of a partial articular supraspinatus tendon avulsion that avoids the transtendinous insertion of suture anchors to preserve the tendon integrity.

Fig 1

View of the left shoulder from the posterior portal with the patient in the beach-chair position. The biceps has been tenotomized. Once the status of the supraspinatus has been assessed and the tendon has been debrided, we proceed with the repair. (L, lateral; M, medial.)

Fig 2

(A) View of the left shoulder from the posterior portal with the patient in the beach-chair position. The curved drill guide is placed through the rotator interval and used to place the anterior and posterior anchors. (B) View from outside the portal with the curved drill in place. (L, lateral; M, medial.)

Fig 3

(A) View of the left shoulder from the posterior portal with the patient in the beach-chair position. A spinal needle is used to place shuttling sutures through the desired repair site. (B) View of sutures after shuttling has occurred. (A, anterior; L, lateral; M, medial.)

Fig 4

View of the left shoulder from the posterior lateral portal with the patient in the beach-chair position. The tied sutures have been delivered down to the bursal side of the supraspinatus. (Ca, caudal; Ce, cephalic; L, lateral; M, medial.)

Fig 5

View of the left shoulder from the posterior lateral portal with the patient in the beach-chair position. The sutures are loaded into a lateral-row anchor and impacted into the lateral cortex of the humeral head. The sutures are then tensioned appropriately. (Ca, caudal; Ce, cephalic; L, lateral; M, medial.)

Fig 6

View of the left shoulder from the posterior portal with the patient in the beach-chair position. The repair has been completed, and the glenohumeral joint is re-entered to verify the reduction of the supraspinatus down to bone. (L, lateral; M, medial.)