Arthroscopic Management of Partial-Thickness Rotator Cuff Tears (PASTA) In Situ and Takedown Techniques

Introduction

Partial-thickness rotator cuff tears (PASTA) are reported to be a common disorder of the shoulder. Improvements in imaging such as magnetic resonance imaging (MRI) and arthroscopic procedures have allowed more accurate characterization of partial rotator cuff tears. In recent years, arthroscopic transtendon or takedown repairs have been reported with good results and without statistically significant differences between techniques related to force or patient satisfaction.

Procedure

• Arthroscopy is performed with the patient in the lateral decubitus or beach chair position, utilizing locoregional anesthesia, and using three portals (anterior, posterior, lateral).

• Assessment of the uncovered footprint with the probe.

• Transtendon approach versus takedown and repair.

• One triple-loaded metal anchor.

Patient History

• <50 years of age

• Male active in sport/athletics

• Subtle onset of shoulder pain after overhead work/sport

• Pain during the night

Patient Examination

• Usually patients maintain full active range of motion (ROM); although there are differing degrees of stiffness

• Jobe test negative but painful

• Palm up test sometimes positive

• O’Brien test sometimes positive

• Belly press negative

• Patte test negative

Imaging

• MRI is useful to confirm and assess partial supraspinatus tears and to exclude full-thickness tears.

• Radiographs should be obtained to exclude calcific tendonitis. Radiograph views should include anteroposterior, scapular Y, and axillary.

Treatment Options

• Step 1: Rest

• Step 2: Nonsteroidal anti-inflammatory drugs (NSAIDs)

• Step 3: Rehabilitation protocol for at least 3 months, with the goal of recovery of full active ROM and strengthening of scapulothoracic muscles

• Step 4: Arthroscopy procedure: takedown and repair or transtendon repair

Surgical Anatomy

• Partial articular supraspinatus tendon avulsion ( Fig. 18.1 )

  
  

• Uncovered footprint

• Synovitis

• Bursitis

Surgical Indications

• The first step of treatment is usually conservative, but in demanding patients, surgery could be an option even as a first step.

• Surgery is indicated in cases of failure of rehabilitation treatment.

Surgical Technique Setup