When faced with a repairable PASTA lesion (typically small tendon retraction and 40-50% footprint exposure), surgeons have two options: either complete the tear followed by a standard rotator cuff repair, or maintain the remaining bursal fibers and perform a transtendinous repair.

Studies have shown drawbacks to completing the tear, including creating a length tension mismatch¹, changing the normal biomechanics of the cuff, and creating a greater potential for non-anatomic recreation.² Conversely, comparing these two approaches has shown a transtendinous approach provides less statistically significant gapping, higher mean ultimate failure strength, and biomechanic superiority.²

A transtendon approach is a reliable procedure that can be expected to produce a good outcome with significant pain relief and improved shoulder scores in 98% of patients.^3,4 Studies have shown that smaller anchors cause less damage to tendon tissue and suggest smaller anchors should be considered for transtendon procedures.⁵ CONMED's Y-Knot^® Flex All-Suture anchor provides distinct advantages for transtendinous PASTA repair techniques.