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781-429-7700
team@ortho.boston
PASTA Repair Technique
Partial Articular-Sided Tear Avulsion (PASTA) Repair
Setup
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Beach chair
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Arthrex SutureTak anchors x 2 (not knotless)
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SutureTak punch (should be in tray)
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18G spinal needles x 4
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#1 PDS shuttling suture
Portals
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Posterior portal (viewing)
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Superior anterolateral portal with 6mm cannula (suture shuttling while in glenohumeral joint)
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Lateral portal with 6 mm cannula (suture tying while in subacromial space)
Technique
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Place scope in posterior portal
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Create superior anterolateral portal just above biceps in the rotator interval and place 6 mm cannula
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Debride the tuberosity footprint with a mechanical shaver
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Remove scope from joint and place in subacromial space
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Create lateral portal and place 6 mm cannula
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Perform a subacromial bursectomy and acromioplasty as indicated
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Remove scope from the subacromial space and place back in the glenohumeral joint
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Place the drill guide and sharp trocar included in the SutureTak kit into the lateral portal
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Penetrate through the rotator cuff in the area that is thin (not the torn, retracted edge of the tear)
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Place drill guide immediately at the junction of the footprint and cartilage in the anterior portion of the tear
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Mallet the SutureTak punch through the drill guide (I prefer to preserve bone and do not to use the drill)
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Place Arthrex SutureTak anchor and remove drill guide
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Leave sutures in lateral cannula, and place a second SutureTak anchor in the posterior aspect of the footprint using the same technique
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Remove one suture from each anchor (you can use these sutures if the tear is larger)
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Pass four 18G needles percutaneously through the retracted edge of the torn tendon
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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
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Retrieve a suture limb from the anterior anchor through the superior anterolateral cannula
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Pass a #1 PDS through the most anterior 18G needle and retrieve this suture with a grasper through the superior anterolateral cannula
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Hold the PDS suture firmly and remove the needle
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Tie a knot in the PDS suture and secure the fiberwire suture limb
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Pull on the PDS limb that is exiting the shoulder laterally to shuttle the fiberwire though the rotator cuff
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The next most posterior 18G needle will be used to shuttle the second suture limb from the anterior anchor
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The posterior two 18G needles are used to shuttle the suture limbs from the posterior anchor
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Once all sutures have been passed, remove the scope from the glenohumeral joint and place in the subacromial space
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Tie each set of sutures in the subacromial space
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Pull all four sutures limbs laterally into a lateral row Arthrex Swivelock anchor to compress any tendon that is not against the footprint
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Cut remaining sutures
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Place cameral back in glenohumeral joint to confirm anatomic repair of tendon
Post-Operative Plan
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Partial Articular-Sided Tear Avulsion (PASTA) Repair
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