Clinical benefits of a
transtendinous technique
for treating PASTA lesions


Complete the Tear or PASTA Repair?

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 mismatch,1

changing the normal biomechanics of the cuff and creating a greater potential for non-anatomic recreation.5 Conversely, research has shown that a transtendinous technique that preserves native tissue provides distinct advantages.


“Studies have shown drawbacks to completing the tear including...
changing the normal biomechanics of the cuff and creating
a greater potential for nonanatomic recreation.” 

- Don A. Buford, MD
Sports Medicine Clinic of North Texas
Paid CONMED Consultant

Less Gapping, Higher Strength and Better Biomechanics

Research comparing these two approaches has shown a transtendinous approach provides statistically significant less gapping, higher mean ultimate failure strength and biomechanic superiority.5

Native, Anatomic Footprint

Literature by Dr. Lo and Dr. Burkhart has shown an arthroscopic transtendon technique can reestablish the normal footprint of the rotator cuff and potentially minimize and length-tension mismatch of the repaired rotator cuff muscles.1 This could result in a more natural, anatomic repair for your patient.5

Excellent Clinical Outcomes

A study by Dr. Castagna found that 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

Similarly, a study by Dr. Snyder found that these repairs provide reliable and sustained pain relief and improvements in shoulder function.2


“To better preserve the native footprint, performing transtendonous repairs is a tried-and-true method of repairing a partial-articular sided tear.” 

- Alessandro Castagna, MD
Humanitas Research Hospital
Paid CONMED Consultant
Yknot Flex
CONMED Solution
Transtendinous PASTA Repair with Y-Knot®
Flex All-Suture Anchors

While surgeons have many anchor choices, with their small size and strong fixation, our Y-Knot® Flex All-Suture Anchors provide distinct advantages for transtendinous PASTA repairs:

Less Invasive Entry

Studies have shown that smaller anchors cause less damage to tendon tissue and suggest smaller anchors should be considered for transtendon procedures.6 At 1.8mm, our Y-Knot® Flex anchors

are the smallest double-loaded all-suture anchors available, helping provide a less invasive percutaneous delivery.

Strong Fixation with Less Bone Removal

Double-loaded with two strands of #2 Hi-Fi® suture, Y-Knot Flex 1.8mm anchors provide 380 N4 fixation strength while removing up to 80% less bone.4


“Because anchors are placed at the articular margin when performing a PASTA repair, where bone density tends to be higher, a smaller anchor such as the 1.8mm Y-Knot Flex that deploys to about 3.0mm has sufficient pullout strength to maintain compression with a transosseous equivalent construct during the healing period.” 

- L. Pearce McCarty III, M.D.
Sports and Orthopaedic Specialists
Paid CONMED Consultant

Y-Knot Flex® anchors enable multiple technique options including:


One or two anchors placed medially, horizontal mattress stitch configuration.


Two anchors placed medially, mattress stitches medially, suture passed to PopLok® 3.5mm or 4.5mm knotless anchors.


Two anchors placed medially, sutures are tied together to compress the supraspinatus to the medial footprint without any additional suture passing steps.

Load to Failure

1 Lo and Burkhart, Transtendon arthroscopic repair of partial-thickness, articular surface tears of the rotator cuff, Arthroscopy, 2004. 2 Snyder et al. Long-term outcome for arthroscopic repair of partial articular-sided supraspinatus tendon avulsion, Arthroscopy, 2013. 3 Castagna et al., Predictive factors of subtle residual shoulder symptoms after transtendinous arthroscopic cuff repair, American Journal of Sports Medicine, 2009. 4 Data on File. 5 Gonzalez-Lomas et al., J Shoulder Elbow Surg 2008; 17:722-728. 6 Qing-Song Zhang et al., Comparison of the tendon damage caused by four different anchor systems used in transtendon rotator cuff repair, Advances in Orthopaedics, 2012.