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.

Partial Articular Supraspinatus Tendon Avulsion Repair and Patch: A Technical Note for Augmenting the Supraspinatus Reinsertion with the Long Head of the Biceps Tendon

“…There are several techniques employed for repairing PASTA, most of them focusing on variations of debridement and anchor fixation 8–12 . However, the biceps tendon‐supraspinatus complex biomechanical relationship may influence the tear characteristics, especially in young and active patients with borderline sized lesions, that make choosing between repair or debridement with or without long head of the biceps tendon (LHBT) tenodesis not as straight‐forward, and currently there is little data on this matter 13–15 .…”

“…3 There are several techniques employed for repairing PASTA, most of them focusing on variations of debridement and anchor fixation. [8][9][10][11][12] However, the biceps tendonsupraspinatus complex biomechanical relationship may influence the tear characteristics, especially in young and active patients with borderline sized lesions, that make choosing between repair or debridement with or without long head of the biceps tendon (LHBT) tenodesis not as straight-forward, and currently there is little data on this matter. [13][14][15] Reports on medial rotator-cuff failure following repair of PASTA lesions, especially after transtendon repair, have noted that although clinical outcomes seem to improve following repair, there is still a high incidence of failure and progression towards full-thickness rotator-cuff defects.…”