1. The “Double-Pulley” Technique for Arthroscopic Fixation of Partial Articular-Side Bony Avulsion of the Supraspinatus Tendon: A Rare Case of Bony PASTA Lesion 
Luigi Murena, M.D., Gianluca Canton, M.D., Daniele A. Falvo, M.D., Eugenio A. Genovese, M.D., Michele F. Surace, M.D., Paolo Cherubino, M.D. 
Arthroscopy Techniques 
Volume 2, Issue 1, Pages e9-e14 (February 2013)
DOI: /j.eats
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2. Fig 1
Preoperative imaging obtained after patient’s complaint of right shoulder pain after a car accident: plain anteroposterior radiograph (A) showing partial articular-side greater tuberosity fracture (oval) and MRI coronal (B, C) and sagittal (D) views showing displaced bony fragment with medial supraspinatus tendon insertion attached. The lateral tendon insertion to the footprint is intact. Greater tuberosity bone edema suggests an acute lesion.
Arthroscopy Techniques 2013 2, e9-e14DOI: ( /j.eats )
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3. Fig 2
Arthroscopic reduction and fixation of bony PASTA lesion: surgical technique in a right shoulder, with the patient in the beach-chair position, by use of a 30° arthroscope. (A) Identifying bony avulsion on the greater tuberosity (articular side, posterior viewing portal). The asterisks indicate the 2 main bony fragments with the medial articular tendon insertion still attached. (B) Measurement of lesion (articular side, posterior viewing portal, probe in anterior portal). (C) Intact rotator cuff on bursal side (bursal side, lateral viewing portal). The arrow indicates the site of lesion on the articular side marked with a Monoplus suture. (D) Position of posterior (A1) and anterior (A2) suture anchors (articular side, posterior viewing portal, probe in anterior portal). (E) Final “rectangle” configuration of sutures and knots (bursal side, lateral viewing portal). The black dotted line indicates the double pulley, and the blue dotted line indicates the simple stitches. (F) Assessment of stability of avulsed fragment after repair (articular side, posterior viewing portal, probe in anterior portal) showed restoration of anatomic supraspinatus tendon insertion with good stability. (HH, humeral head; SS, supraspinatus.)
Arthroscopy Techniques 2013 2, e9-e14DOI: ( /j.eats )
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4. Fig 4
Postoperative imaging after arthroscopic reduction and fixation of a bony PASTA lesion with 2 suture anchors in double-pulley configuration. (A) Anteroposterior radiograph showing correct position of suture anchors and reduction of bony fragments. (B-D) Arthro-MRI coronal views at 2 months showing watertight repair of rotator cuff and reconstruction of supraspinatus footprint.
Arthroscopy Techniques 2013 2, e9-e14DOI: ( /j.eats )
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5. Fig 3
Clinical range of motion at 2 months’ follow-up after arthroscopic repair of bony PASTA lesion showing mild deficit of elevation and internal rotation.
Arthroscopy Techniques 2013 2, e9-e14DOI: ( /j.eats )
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6. Fig 5
Bony PASTA lesion and surgical technique for its treatment. (A) Bony partial avulsion of greater tuberosity with medial tendon insertion still attached. (B) Position of suture anchors and suture limbs. (C) Final configuration of sutures on bursal side after repair, showing double pulley in blue and simple stitches in green (i.e., “rectangle of sutures”).
Arthroscopy Techniques 2013 2, e9-e14DOI: ( /j.eats )
Copyright © 2013 Arthroscopy Association of North America Terms and Conditions