Abstract
The partial articular surface tendon avulsion (PASTA) is a common lesion that involves
the supraspinatus tendon in most cases. We present an arthroscopic fixation technique
for a previously undescribed lesion that may be considered a variant of the PASTA.
The lesion involves a partial avulsion of the greater tuberosity with an intact deep
insertion of the supraspinatus tendon into the fractured bone fragment and an intact
superficial insertion of the supraspinatus into the unavulsed lateral aspect of the
greater tuberosity: a “bony PASTA” lesion. The surgical technique involves the use
of a 70° arthroscope to provide an “end-on” view of the pathology. A superior-medial
transmuscular portal is used for anchor insertion and suture management; the portal
avoids damage to the intact tendinous insertion of the supraspinatus, which can occur
during transtendon anchor/screw insertion. Abduction of the arm to 50°, after creation
of the portal and passage of the cannula, permits an optimal “deadman” angle of anchor
placement. An angled suture grasper is used to retrieve the 4 suture strands from
the double-loaded suture anchor through the intact superficial and deep supraspinatus
tendon fibers along the length of the fracture; these are tied as 2 mattress sutures
over the tendon fibers in the subacromial space by use of sliding-locking knots. Adequacy
of reduction is confirmed by intra-articular arthroscopic observation during movement
of the extremity through its complete range of motion.
Key Words
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Article info
Publication history
Published online: February 16, 2007
Footnotes
The authors report no conflict of interest.
Cite this article as: Bhatia DN, de Beer JF, van Rooyen KS. The bony partial articular surface tendon avulsion lesion: An arthroscopic technique for fixation of the partially avulsed greater tuberosity fracture. Arthroscopy 2007;23:786.e1-786.e6 [doi:10.1016/j.arthro.2006.10.024].
Identification
Copyright
© 2007 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.
