PASTA Repair Surgical Technique

Complete the Tear or PASTA Repair?

When faced with a repairable PASTA lesion, typically small tendon retraction and 40-50% footprint exposure, surgeons have two options: either complete the tear followed by a standard rotator cuff repair or maintain the remaining bursal fibers and perform a transtendinous repair.

Studies have shown drawbacks to completing the tear including creating a length tension mismatch,¹ changing the normal biomechanics of the cuff and creating a greater potential for non-anatomic recreation.² Conversely, comparing these two approaches has shown a transtendinous approach provides statistically significant less gapping, higher mean ultimate failure strength and biomechanic superiority.² Literature by Dr. Lo and Dr. Burkhart has shown an arthroscopic transtendon technique can reestablish the normal footprint of the rotator cuff and potentially minimize and length-tension mismatch of the repaired rotator cuff muscles.¹ This could result in a more natural, anatomic repair for your patient.²

Excellent Clinical Outcomes

A study by Dr. Castagna found that a transtendon approach is a reliable procedure that can be expected to produce a good outcome with significant pain relief and improved shoulder scores in 98% of patients.³ Similarly, a study by Dr. Snyder found that these repairs provide reliable and sustained pain relief and improvements in shoulder function.⁴

Transtendinous PASTA Repair with Y-Knot^® Flex All-Suture Anchors

While surgeons have many anchor choices, Y-Knot^® Flex All-Suture Anchors provide distinct advantages for transtendinous PASTA repairs. Studies have shown that smaller anchors cause less damage to tendon tissue and suggest smaller anchors should be considered for transtendon procedures.⁵ At 1.8mm, our Y-Knot^®Flex anchors are the smallest double-loaded all-suture anchors available, helping provide a less invasive percutaneous delivery. Double-loaded with two strands of #2 Hi-Fi^® suture, Y-Knot Flex 1.8mm anchors provide 380N fixation strength while removing up to 80% less bone.⁶
Y-Knot Flex anchors enable multiple technique options, including Single-Row, Double-Row, and Double-Pulley. With the double pulley technique, two anchors are placed medially and the sutures are tied together to compress the supraspinatus to the medial footprint without any additional suture passing steps.

Product

Y-Knot^® Flex All-Suture Anchors 

• Soft: All-suture anchors
• Small: Minimal footprint
• Secure: 360-degree FormFit™ Fixation

PopLok^® Knotless Suture Anchors – 3.5/4.5mm

• Ability to tension suture after the anchor is seated
• Wings are deployed subcortically to provide secure fixation

Super Revo^® FT and ThRevo^®  FT Suture Anchors 

• Self-punching fully-threaded titanium anchor