E-Poster at the Arthroscopy Association of North America Annual Meeting 2012 - PASTA Bridge - A New Technique in PASTA Repairs: A Clinical Evaluation

1. PASTA Bridge - A New Technique in
PASTA Repairs: A Clinical Evaluation
Alan M Hirahara, MD, FRCSC
Private Practice
Sacramento, CA USA

2. Objective of Study
• To evaluate the clinical effectiveness of a new
PASTA repair technique – PASTA Bridge
• To introduce a novel technique in PASTA repair
that is significantly easier, carries less risk, does
not require arthroscopic knot tying, and is as
effective as current trans-tendon techniques

3. Introduction
• In the literature, PASTA lesions can cause significant
pain for patients
• Debridement alone of tears < 50% thickness can result in
good/excellent outcomes but can progress on to full
thickness tears (6.5-34.6%)
• Current repair techniques can lead to excellent results
but are technically challenging

4. Study Design
• Case-control study
• Collection period: 8/09 – 12/11
• Pain scores, ASES scores taken every month for 6
months
– ROM measured pre-op and monthly for 3 months post
– Date of discharge and date of return to work were noted

5. Study Design
• All patients with requiring a PASTA repair
• Inclusions:
– PASTA lesion > 25% thickness
• Exclusions:
– any post-operative trauma
– non-compliance with physical therapy protocol
• Failure to heal:
– Evaluated any symptoms 4-6 months post-op with repeat MRA or
surgery

6. PASTA Bridge Technique
• 17 gauge spinal needle punctures supraspinatus
tendon anterior and medial to tear
• 1.1 mm blunt Nitinol wire through spinal needle
followed by a 2.4 mm portal dialation instrument
followed by the drill spear & drill
• Create pilot hole and insert 2.4 mm
BioComposite SutureTak

7. PASTA Bridge Technique
• Repeat for second anchor posterior to tear
• A strand of suture from each anchor was tied in a
similar manner as the “double pulley” method
• Opposing two limbs were tensioned to pull the
knot taunt over the repair site, and fixated laterally
with a 4.75 mm BioComposite SwiveLock

8. PASTA Bridge Technique

9. Patient Data
Study Group Control Group
• 35 patients • 26 patients
• 15 male / 20 female • 12 male / 14 female
• Age range: 22 – 80 years • Age range: 17 – 72 years
• Age average: 52.07 years • Age average: 47.75 years

10. Results
Pain Scores ASES Scores
p = NS p = NS
7.0 80.0
6.0 70.0
60.0
5.0
50.0
4.0
40.0
3.0
30.0
2.0
20.0
1.0 10.0
0.0 0.0
Pre-op 1 2 3 4 5 6 Pre-op 1 2 3 4 5 6
Month Month Month Month Month Month Month Month Month Month Month Month
 Control Group: n = 26
 Study Group: n = 35

11. Range of Motion
160.0
140.0
120.0
100.0
Control Flexion
Degrees
80.0 Study Flexion
Control ER
60.0
Study ER
40.0
20.0
0.0
Initial Visit 1 Month 2 Month 3 Month
No Significant Difference Between the 2 Groups

12. Results – Return to Work
124.0
140.0
99.8
120.0
100.0
80.0
Days
60.0
40.0
20.0
0.0
Control Group Study Group
No Significant Difference Between the 2 Groups

13. Results – Days to Discharge
p = 0.02
241.7
250.0
200.0
139.7
150.0
Days
100.0
50.0
0.0
Control Group Study Group

14. Results - Failures
p = 0.078
4
3.5
3
4/26
2.5
2
1.5
1
1/35
0.5
0
Control Group Study Group

15. Results
• No significant difference in
– VAS pain scores
– ASES scores
– Return to work
– Failures - 15.4% to 2.9%
• Significant difference in
– Days to discharge

16. Discussion
• The PASTABridge is just as effective as trans-tendon
repairs but
– Easy, percutaneous technique
– Minimal risk of damaging shoulder during surgery
– Proven biomechanical strength
• Will require a randomized controlled trial and larger
sample size to better evaluate the results

17. Discussion: ExtensionBridge
• Can be used to repair wide PASTA lesions that span
supraspinatous to infraspinatous
• These repairs are extremely challenging with any other
technique

18. Conclusion
• The PASTA Bridge is a viable, simple
technique to repair PASTA lesions that carries
minimal risk, compared with current trans-
tendon techniques