Partial Articular Supraspinatus Tendon Avulsion (PASTA) Repair: Transtendinous Technique

Partial articular supraspinatus tendon avulsion (PASTA) lesions are a common cause of shoulder pain and dysfunction. Transtendinous repair is a surgical technique used to restore tendon integrity while preserving intact tendon and minimizing iatrogenic tendon damage.

This technique is indicated in patients with symptomatic, partial-thickness rotator cuff tears who have failed conservative management.

The PASTA transtendinous technique repair is performed in the beach-chair position. The articular-sided tear is visualized, debrided, and 2 suture anchors are placed percutaneously through the tendon into the rotator cuff footprint. The sutures are passed in a boxed mattress configuration, and knot-tying is performed arthroscopically on the bursal side of the cuff, securing the tendon back to its footprint and preserving intact tendon fibers.

This construct demonstrates stable fixation of the tendon to its native footprint, with preservation of tendon integrity. Postoperatively, patients undergo a structured rehabilitation protocol. Return to full activity/sport is expected at approximately 4 to 6 months.

Transtendinous repair of PASTA lesions provides a reliable method for restoring native tendon integrity, while preserving intact tendon fibers. This technique minimizes tendon trauma compared with traditional "take-down" rotator cuff repair techniques, maintains native anatomy, and facilitates anatomic healing with good functional recovery.

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