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All-Inside Arthroscopic Partial Articular-Sided Supraspinatus Tendon Avulsion (PASTA) Repair Without Bunching of the Bursal Side of the Tendon.

ABSTRACT: PASTA (partial articular-sided supraspinatus tendon avulsion) lesions are supraspinatus tendon tears involved the articular surface. PASTA lesions are commonly repaired using trans-tendon repair or tendon takedown and repair. Systematic reviews have shown that both techniques can improve shoulder function similarly. The advantages of trans-tendon repair are the preservation of the intact tendon and superior biomechanical strength. However, there is a risk that the tendon will become overtensioned and that the technique will create tendon bunching on the bursal side, resulting in imbalanced tendon tension. This Technical Note describes an all-inside arthroscopic trans-tendon repair technique of PASTA lesion without bunching the tendon's bursal side.

SUBMITTER: Itthipanichpong T

PROVIDER: S-EPMC9244634 | biostudies-literature | 2022 Jun

REPOSITORIES: biostudies-literature

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All-Inside Arthroscopic Partial Articular-Sided Supraspinatus Tendon Avulsion (PASTA) Repair Without Bunching of the Bursal Side of the Tendon.

Itthipanichpong Thun T Thamrongskulsiri Napatpong N Limskul Danaithep D Tanpowpong Thanathep T

Arthroscopy techniques 20220521 6

PASTA (partial articular-sided supraspinatus tendon avulsion) lesions are supraspinatus tendon tears involved the articular surface. PASTA lesions are commonly repaired using trans-tendon repair or tendon takedown and repair. Systematic reviews have shown that both techniques can improve shoulder function similarly. The advantages of trans-tendon repair are the preservation of the intact tendon and superior biomechanical strength. However, there is a risk that the tendon will become overtensione ...[more]

PMID: 35782853

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Project description:IntroductionRotator cuff constitutes a mechanical arm and an important stabilizing factor for the shoulder joint, and the supraspinatus muscle is the initiator of the movement of arm in the abduction direction. Rotator cuff injuries constitute an important part of the shoulder pain, and many cases are managed conservatively, nevertheless, open or arthroscopic surgery remains a must in many cases.Case reportWe present the case of a patient in the sixth decade of life who complained of absence of abduction movement in his right shoulder three months ago after he lifted a heavy object. The clinical examination showed a positive sign of drop arm and other clinical signs indicating absence of supraspinatus muscle function. The MRI also showed a full-thickness tear of the supraspinatus tendon and its retraction away from its original inserting point on the greater tuberosity of the humerus. The case was managed by re-implanting the ruptured tendon by combining arthroscopic and open surgeries and using two anchors with slipable sutures, adopting the principles of duplicated knots and multiple transverse entry through the tendon to get a firm fulcrum. The results were clearly good after rehabilitation with a wide and powerful ROM (Range of Motion).DiscussionMany cases of RCT (Rotator Cuff Tears) are concretively managed by using corticosteroids injections into the subacromial space with results of significant improvement in symptoms, and arthroscopic surgery is of increasing importance in preventing the development of small partial or full thickness tears and in reconnecting complete or avulsion tears early. The current case is characterized by a clear contraction of the completely avulsed tendon with severe adhesions due to neglection of the case for several months, which made the possibilities of arthroscopic surgeries limited only by acromioplasty, loosening some adhesions and preparation of the footprint, as well as making open surgery mandatory to give a wide area for doubling the suturing layers and then re-implanting the avulsed tendon into its original anchor.ConclusionNeglect and delay in managing full-thickness tears in the supraspinatus tendon are the important reasons for the occurrence of adhesions and fibrosis, which in turn hinder the process of re-implanting the ruptured tendon at its original anchor through arthroscopic surgery, so that open surgery becomes the mandatory solution. It is necessary to use anchors with slipable threads and to focus on doubling the suturing layers with repeatedly entering through the muscle tendon to reduce it to the footprint firmly and strongly by tightening the slipable threads through the anchors.

Project description:BackgroundAt present, shoulder arthroscopy is usually used for treatment of rotator cuff injuries. There is still debate over the precise technique of using shoulder arthroscopy to treat partial articular-sided supraspinatus tendon injuries.ObjectiveTo compare the clinical efficacy of the arthroscopic transtendon repair method and the arthroscopic full-thickness repair method in the treatment of patients with Ellman III partial articular-sided supraspinatus tendon tears and to analyze the influencing factors of postoperative efficacy.Study designCohort study; level of evidence,4.MethodsA total of 84 partial-thickness rotator cuff tear (PTRCT) patients with Ellman III injuries who underwent surgical treatment in our hospital between January 2017 and January 2020 were selected and divided into the arthroscopic trans-tenon repair group (32 cases) and the arthroscopic full-thickness repair group (52 cases). Shoulder joint pain and functional status were assessed by the Constant score, ASES score and VAS score; shoulder mobility was assessed by measuring shoulder ROM. The clinical outcomes of the two groups of patients were compared, and the factors affecting the postoperative efficacy of the patients were investigated.ResultsAll patients were followed up for at least 2 years. The Constant score, ASES score, and VAS score of the two groups of patients were all improved compared with those before surgery, and the differences were statistically significant (P < 0.05). There were no significant differences in the Constant score, ASES score, or VAS score between the two groups (P > 0.05). The results of binary logistic regression analysis showed that the preoperative ASES score and whether biceps tenotomy was performed were independent risk factors for satisfactory postoperative efficacy (P < 0.05).ConclusionFor patients with Ellman III partial articular-sided supraspinatus tendon tears, the arthroscopic transtendon repair method and the arthroscopic full-thickness repair method can both significantly improve the shoulder pain and function of the patient, but there is no significant difference between the efficacy of the two surgical methods. The preoperative ASES score and whether biceps tenotomy was performed were independent risk factors for satisfactory postoperative efficacy in PTRCT patients with Ellman III injury.

Dataset Information

All-Inside Arthroscopic Partial Articular-Sided Supraspinatus Tendon Avulsion (PASTA) Repair Without Bunching of the Bursal Side of the Tendon.

Publications

All-Inside Arthroscopic Partial Articular-Sided Supraspinatus Tendon Avulsion (PASTA) Repair Without Bunching of the Bursal Side of the Tendon.

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