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PASTA Repair Technique

Partial Articular-Sided Tear Avulsion (PASTA) Repair


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


  • 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)


  • 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
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