Advertisement

The Bony Partial Articular Surface Tendon Avulsion Lesion: An Arthroscopic Technique for Fixation of the Partially Avulsed Greater Tuberosity Fracture

Published:February 16, 2007DOI:https://doi.org/10.1016/j.arthro.2006.10.024

      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

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Arthroscopy
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Codman E.A.
        The shoulder. R. E. Krieger, Malabar (FL)1984
        • Snyder S.J.
        • Pachelli A.F.
        • Del Pizzo W.
        • Friedman M.J.
        • Ferkel R.D.
        • Pattee G.
        Partial thickness rotator cuff tears: Results of arthroscopic treatment.
        Arthroscopy. 1991; 7: 1-7
        • Souryal T.O.
        • Baker C.L.
        Anatomy of the supraclavicular fossa portal in shoulder arthroscopy.
        Arthroscopy. 1990; 6: 297-300
        • Burkhart S.S.
        The deadman theory of suture anchors: Observations along a South Texas fence line.
        Arthroscopy. 1995; 11: 119-123
        • Walch G.
        • Levigne C.
        Partial-thickness cuff tears.
        in: Gazielly D.F. Gleyze P. Thomas T. The cuff. Elsevier, Paris1997: 231-233
        • Green A.
        • Izzy J.
        Isolated fractures of the greater tuberosity of the proximal humerus.
        J Shoulder Elbow Surg. 2003; 12: 641-649
        • Kim S.H.
        • Ha K.I.
        Arthroscopic treatment of symptomatic shoulders with minimally displaced greater tuberosity fracture.
        Arthroscopy. 2000; 16: 695-700
        • Kaspar S.
        • Mandel S.
        Acromial impression fracture of the greater tuberosity with rotator cuff avulsion due to hyperabduction injury of the shoulder.
        J Shoulder Elbow Surg. 2004; 13: 112-114
        • Waibl B.
        • Buess E.
        Partial-thickness articular surface supraspinatus tears: A new transtendon suture technique.
        Arthroscopy. 2005; 21: 376-381
        • Lo I.K.Y.
        • Burkhart S.S.
        Transtendon arthroscopic repair of partial-thickness, articular surface tears of the rotator cuff.
        Arthroscopy. 2004; 20: 214-220
        • Lyons T.R.
        • Savoie III, F.H.
        • Field L.D.
        Arthroscopic repair of partial-thickness tears of the rotator cuff.
        Arthroscopy. 2001; 17: 219-223
        • Carrera E.F.
        • Matsumoto M.H.
        • Netto N.A.
        • Faloppa F.
        Fixation of greater tuberosity fractures.
        Arthroscopy. 2004; 20 (Available online at www.arthroscopyjournal.org): e109-e111
        • Neviaser T.J.
        Arthroscopy of the shoulder.
        Orthop Clin North Am. 1987; 18: 361-372