Rotator cuff tears are very common. They can be either traumatic or degenerative in nature. Many tears can be successfully treated nonoperatively with physical therapy or home exercises. For patients in whom conservative measures fail, there are a variety of ways to repair the rotator cuff. Despite our advances in knowledge about rotator cuff tears, improved technology, and advanced repair techniques, failure rates after surgery are still high. Large tears that are deemed irreparable can be treated with partial repair, debridement, tendon transfers such as a latissimus dorsi transfer or lower trapezius transfer, biceps tenotomy or tenodesis, superior capsular reconstruction, bridge grafting, or even arthroplasty options such as a hemiarthroplasty or reverse total shoulder arthroplasty. No technique has proved vastly superior to another, and there are many advantages and disadvantages of each surgical procedure. Add balloon spacer implantation to that list. A surgeon can now place a subacromial balloon spacer to help improve functional outcomes and reduce pain in patients with irreparable rotator cuff tears. Studies have shown promising results, with improvements in strength and range of motion, as well as reductions in pain. Outcomes have only been studied in the short term, so much is still unknown about the full effects of this treatment. More studies are needed to find out whether the results persist into the long term and to confirm that complications do not arise that may complicate future procedures such as a reverse total shoulder arthroplasty.

The Latarjet procedure is a well-established treatment for shoulder instability. It is traditionally used for recurrent instability with significant bone loss (i.e. >20%) or after failed soft tissue procedures. It can be done open or arthroscopically with either a subscapularis takedown or a split. It has good long-term results regarding recurrence and clinical outcomes. Unfortunately, it has higher complication rates in comparison to its alternative procedures such as arthroscopic Bankart repair or open Bankart repair. These complications may be due to the learning curve of performing the procedure and lack of proper training. The Latarjet procedure is a necessary tool to treat shoulder instability. We need better training and exposure to Latarjet procedures in residency, fellowship, and clinical practice so that more providers can do this procedure for our patients, but we need to do it more safely.