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

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