PASTA Repair Technique

Partial Articular-Sided Tear Avulsion (PASTA) Repair

Setup

Beach chair
Arthrex SutureTak anchors x 2 (not knotless)
SutureTak punch (should be in tray)
18G spinal needles x 4
#1 PDS shuttling suture

Portals

Posterior portal (viewing)
Superior anterolateral portal with 6mm cannula (suture shuttling while in glenohumeral joint)
Lateral portal with 6 mm cannula (suture tying while in subacromial space)

Technique

Place scope in posterior portal
Create superior anterolateral portal just above biceps in the rotator interval and place 6 mm cannula
Debride the tuberosity footprint with a mechanical shaver
Remove scope from joint and place in subacromial space
Create lateral portal and place 6 mm cannula
Perform a subacromial bursectomy and acromioplasty as indicated
Remove scope from the subacromial space and place back in the glenohumeral joint
Place the drill guide and sharp trocar included in the SutureTak kit into the lateral portal
Penetrate through the rotator cuff in the area that is thin (not the torn, retracted edge of the tear)
Place drill guide immediately at the junction of the footprint and cartilage in the anterior portion of the tear
Mallet the SutureTak punch through the drill guide (I prefer to preserve bone and do not to use the drill)
Place Arthrex SutureTak anchor and remove drill guide
Leave sutures in lateral cannula, and place a second SutureTak anchor in the posterior aspect of the footprint using the same technique
Remove one suture from each anchor (you can use these sutures if the tear is larger)
Pass four 18G needles percutaneously through the retracted edge of the torn tendon
The key is to keep the needles "flat" to the tuberosity so they are entering from a more lateral position and not a superior position
Retrieve a suture limb from the anterior anchor through the superior anterolateral cannula
Pass a #1 PDS through the most anterior 18G needle and retrieve this suture with a grasper through the superior anterolateral cannula
Hold the PDS suture firmly and remove the needle
Tie a knot in the PDS suture and secure the fiberwire suture limb
Pull on the PDS limb that is exiting the shoulder laterally to shuttle the fiberwire though the rotator cuff
The next most posterior 18G needle will be used to shuttle the second suture limb from the anterior anchor
The posterior two 18G needles are used to shuttle the suture limbs from the posterior anchor
Once all sutures have been passed, remove the scope from the glenohumeral joint and place in the subacromial space
Tie each set of sutures in the subacromial space
Pull all four sutures limbs laterally into a lateral row Arthrex Swivelock anchor to compress any tendon that is not against the footprint
Cut remaining sutures
Place cameral back in glenohumeral joint to confirm anatomic repair of tendon

Post-Operative Plan

Partial Articular-Sided Tear Avulsion (PASTA) Repair

PASTA Repair Technique

Partial Articular-Sided Tear Avulsion (PASTA) Repair

Setup

Beach chair

Arthrex SutureTak anchors x 2 (not knotless)

SutureTak punch (should be in tray)

18G spinal needles x 4

#1 PDS shuttling suture

Portals

Posterior portal (viewing)

Superior anterolateral portal with 6mm cannula (suture shuttling while in glenohumeral joint)

Lateral portal with 6 mm cannula (suture tying while in subacromial space)

Technique

Place scope in posterior portal

Create superior anterolateral portal just above biceps in the rotator interval and place 6 mm cannula

Debride the tuberosity footprint with a mechanical shaver

Remove scope from joint and place in subacromial space

Create lateral portal and place 6 mm cannula

Perform a subacromial bursectomy and acromioplasty as indicated

Remove scope from the subacromial space and place back in the glenohumeral joint

Place the drill guide and sharp trocar included in the SutureTak kit into the lateral portal

Penetrate through the rotator cuff in the area that is thin (not the torn, retracted edge of the tear)

Place drill guide immediately at the junction of the footprint and cartilage in the anterior portion of the tear

Mallet the SutureTak punch through the drill guide (I prefer to preserve bone and do not to use the drill)

Place Arthrex SutureTak anchor and remove drill guide

Leave sutures in lateral cannula, and place a second SutureTak anchor in the posterior aspect of the footprint using the same technique

Remove one suture from each anchor (you can use these sutures if the tear is larger)

Pass four 18G needles percutaneously through the retracted edge of the torn tendon

The key is to keep the needles "flat" to the tuberosity so they are entering from a more lateral position and not a superior position

Retrieve a suture limb from the anterior anchor through the superior anterolateral cannula

Pass a #1 PDS through the most anterior 18G needle and retrieve this suture with a grasper through the superior anterolateral cannula

Hold the PDS suture firmly and remove the needle

Tie a knot in the PDS suture and secure the fiberwire suture limb

Pull on the PDS limb that is exiting the shoulder laterally to shuttle the fiberwire though the rotator cuff

The next most posterior 18G needle will be used to shuttle the second suture limb from the anterior anchor

The posterior two 18G needles are used to shuttle the suture limbs from the posterior anchor

Once all sutures have been passed, remove the scope from the glenohumeral joint and place in the subacromial space

Tie each set of sutures in the subacromial space

Pull all four sutures limbs laterally into a lateral row Arthrex Swivelock anchor to compress any tendon that is not against the footprint

Cut remaining sutures

Place cameral back in glenohumeral joint to confirm anatomic repair of tendon

Post-Operative Plan

Partial Articular-Sided Tear Avulsion (PASTA) Repair

Hours