Name: Arthroscopic Management of a PASTA Lesion With CuffMend™ Dermal Allograft in an Overhead Athlete
Uploaded: 2026-09-01T00:00:00Z
Channel: Arthrex

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Patrick A. Smith, MD (Naples, FL), presents a revision case of a collegiate volleyball athlete with persistent pain following a prior SLAP repair, highlighting evaluation and management of a partial articular-sided supraspinatus avulsion (PASTA lesion). Dr. Smith demonstrates arthroscopic debridement and dermal allograft augmentation using the CuffMend™ system, emphasizing graft delivery, fixation techniques, and biologic healing benefits. Postoperative imaging and clinical outcomes demonstrate effective tendon healing and a successful return to play, reinforcing the role of dermal allografts in complex shoulder repairs.

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VID1-010026-en-US | A | Arthroscopic Management of a PASTA Lesion With CuffMend™ Dermal Allograft in an Overhead Athlete

Patrick A. Smith

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Arthroscopic Management of a PASTA Lesion With CuffMend™ Dermal Allograft in an Overhead Athlete

Speaker  Hi, I'm Pat Smith from Naples, Florida, and I'd like to present a very interesting case of a college beach volleyball player who had a recurrent slap tear. So her history, it's her right shoulder and she's right hand dominant. She had a slap repair three years ago when I saw her. She continued to have anterior pain, especially overhead hitting activity. Interestingly, she also had pain at night affecting her sleep. She had no history of instability, and she had worked hard on a rehab program with the training staff at college without improvement. On exam, she was tender anteriorly over her biceps tendon. She had full motion. Interestingly, though, she was definitely weak. When I stretched her supraspinatus at 4 or 5, she had a positive O'Brien's maneuver and thumb down position positive speed's test, but was stable on load and shift. Routine X-rays look fine, other than some shadows from her previous anchor placement in the glenoid from her slap repair. So she had had a pre-op MRI previously that was without contrast, as you see here. And there's some signal with the supraspinatus anteriorly. But being a revision case, I always like to get a contrast MRI if I have any questions. And so I went ahead and did that. And you can see here now the leakage of dye anteriorly in the supraspinatus consistent with an articular sided pasta type tear here. Speaker  Anteriorly well seen. And there's a bit of signal also up toward the labrum superiorly as well. So this is the sagittal projection also done preoperatively when I saw her to get this additional information. And again just basically shows this pasta lesion as well as something up toward the superior labrum. Here's her diagnostic arthroscopy. You can see the old blue sutures from a previous slap repair. You see a significant partial articular sided supraspinatus tear. She had some chondral changes on both the humeral head and the glenoid. To me that were consistent with her slap lesion. One of the sutures was actually noosed around the base of the biceps. So the previous slap repair, which we know can be difficult for healing, did not work in this overhead athlete. And so the question here was what was I going to do especially to the biceps. Do I leave it. Do I do a tenodesis. And what about the rotator cuff? So then we went to do the work that I felt needed to be done. First. I cleaned up the joint. I took out all these sutures here, as you see, and then I'll clean up the labrum up superiorly with my shaver. I looked closely at the biceps. The tendon quality was pretty good, you know, it was a little bit unstable toward the attachment, but in an overhead athlete, right hand dominant. Speaker  I elected to leave the biceps here. So I did the labral debridement. Again, you can see the changes up on that superior glenoid. So joints not perfect. And then I debrided this significant partial supraspinatus tear and then had to make a decision. But I went back to my preoperative evaluation. She had significant pain, especially at night. Acted like a rotator cuff with weakness. So I felt I had to do something to the rotator cuff. So what I decided to do was to do a CuffMend dermal allograft. So here I marked the glenoid so I would avoid any penetration of the humeral head or glenoid or the biceps tendon, and cleaned up some of the Bursa. I did not do any decompression of the bone though. And there's my mark where I want to place my graft. So utilize the graft spreader to deliver the dermal allograft in proper position. I fixate medially with two FiberStitch rotator cuff anchors, which give excellent fixation one posteriorly, the other anteriorly, and then laterally. I utilize push locks for my lateral fixation. Post-operatively. She was in a sling for four weeks. I started pendulum exercises early to minimize stiffness, which was started at one week. Table slides at two weeks. She was walking up a wall. Speaker  At three weeks. She had active motion at four weeks and I said, okay, let's let her go. And we started some like cuff strengthening at eight weeks. So then I decided to decided to get an MRI post-op to help with return to play decision making, just with contrast, which I thought would be best to really see what was happening. And you can see that outpouching of that pasta lesion is gone now with the dye in the joint. Very surprised at this at just five months. But it looked like we had some major healing here. And then in comparison Preoperatively looking at images, this was their non-contrast study. And you can see the difference here on the right. The cuff looks very nice compared to that increased area of white and outpouching on the left. And look what contrast. So again you can definitely see the pasta lesion. Preoperatively postoperatively. It looks gone the exact same. Cut another one here. And so her cuff looked fully healed. And so to me this really suggested that the dermal allograft was also having an inductive biologic characteristic of this significant lesion. Here she is at six months returned to play. It's her dominant right arm. And here she can spike the ball. So she's been doing excellently, having no issues back playing college beach volleyball. Speaker  And.

Aumento del manguito rotador de espesor parcial con CuffMend™

Arthroscopic Management of a PASTA Lesion With CuffMend™ Dermal Allograft in an Overhead Athlete

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