Arthroscopic partial repair with versus without biodegradable subacromial spacer for patients with massive rotator cuff tears: a case–control study

Malahias, Michael Alexander; Brilakis, Emmanouil; Avramidis, Grigorios; Trellopoulos, Angelos; Antonogiannakis, Emmanouil

doi:10.1007/s12306-020-00649-9

Cited by 19 publications

(25 citation statements)

References 22 publications

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“…43 They subsequently undertook a 2-arm intervention looking at partial cuff repairs with and without the use of the balloon spacer and found no significant differences, and therefore could not recommend the use of the device. 49 Outcome measures were also variable, with some studies purely analysing the range of movement, and others including validated patient-reported outcome measures.…”

Section: Clinical Resultsmentioning

confidence: 99%

“…Only four studies did not recommend using the spacer based on their results. 39,49,52,53 In total, four studies performed a double-arm designed study, 3 of these comparing partial cuff repair in conjunction with balloon spacer with balloon spacer alone (Table 2). A further article reported 2 cases of augmentation of a massive rotator cuff repair with the subacromial balloon spacer, with a post-op MRI confirming degradation of the balloon and a film of bursa-like tissue covering the repair.…”

Section: Clinical Resultsmentioning

confidence: 99%

“…As suggested by some recent reviews, there is too much heterogeneity in study design, patient inclusion and concomitant surgery to draw any conclusions. 56e58 Some studies include tears that seem to have potential for repair, with grade 1 or 2 fatty infiltration diagnosed pre-operatively, 43,44,49 and partial repair possible on table. 43,49,50 Almost all studies to date provide level III or IV evidence, and many end by suggesting a randomised protocol study to enable firm conclusions to be drawn.…”

mentioning

confidence: 99%

“…56e58 Some studies include tears that seem to have potential for repair, with grade 1 or 2 fatty infiltration diagnosed pre-operatively, 43,44,49 and partial repair possible on table. 43,49,50 Almost all studies to date provide level III or IV evidence, and many end by suggesting a randomised protocol study to enable firm conclusions to be drawn. In Burnier's review, a treatment algorithm suggests that the subacromial balloon spacer is probably an option in those low demand patients without cartilage degeneration, without pseudoparalysis and with failed non-operative treatment.…”

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confidence: 99%

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Subacromial balloon spacer – Where are we now?

Viswanath

Drew

2021

Journal of Clinical Orthopaedics and Trauma

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Introduction: Rotator cuff tears are a common cause of disability and pain. The ideal treatment for truly irreparable rotator cuffs is still debated, and one recent surgical advance is the development of the subacromial balloon spacer. This review aims to clarify the current evidence and indications for this device. Methods: A comprehensive literature search was undertaken using the MeSH search terms combining "balloon spacer" and "irreparable cuff tear". A total of 20 studies using the balloon spacer as a treatment modality in more than two patients, were analysed. Results: A total of 513 patients were analysed, representing 83% of those initially identified as meeting the inclusion criteria. The majority of studies recommended the device, with only four suggesting it was not recommended based on their results. Notable bias was present in the studies analysed, and there were no papers providing greater than level III evidence. Conclusion:The subacromial balloon spacer is one possible treatment option for older, low-demand patients with a full thickness rotator cuff tear involving only the supraspinatus tendon, who also have no arthritis and have preserved active elevation beyond 90 . However, the results of two large randomised prospective trials are awaited to provide satisfactory evidence regarding the use of the balloon spacer.

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Section: Clinical Resultsmentioning

confidence: 99%

Section: Clinical Resultsmentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

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Subacromial balloon spacer – Where are we now?

Viswanath

Drew

2021

Journal of Clinical Orthopaedics and Trauma

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“…13 If a large rotator cuff tear is irreparable, then even without glenohumeral arthritis, persistent pain and dysfunction may prompt operative intervention. Pain relieving options suggested have been debridement with or without long head of biceps tenotomy, 14 insertion of a balloon spacer 15 and hemiarthroplasty 16 as a limited goal procedure. Other options include partial cuff repair, 17 patch augmentation, 18,19 tendon transfers, 20 superior capsular reconstruction (SCR), 21 and RTSA.…”

Section: Introductionmentioning

confidence: 99%

Reverse total shoulder arthroplasty for irreparable rotator cuff tears without arthritis: A systematic review

Viswanath

Bale

Trail

2021

Journal of Clinical Orthopaedics and Trauma

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Introduction: Indications for reverse total shoulder arthroplasty (RTSA) have expanded over recent years. Whilst cuff tear arthropathy is an accepted indication, the results of its use in those without arthritis is not clear. The aim of this article is to review the literature on RTSA for massive rotator cuff tears without associated arthritis. Methods: A systematic review search was performed in accordance with Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines to find all studies with clinical outcomes on RTSA performed for massive irreparable rotator cuff tears (MIRCT) without arthritis. Results: Of the 160 studies produced by the search, a detailed analysis found 11 articles to be included in this review. There was variability in the implant style used and the outcome measures utilised, but all studies found improvement in the outcome following RTSA. Many studies advised judicious use following high complication rates, and caution was advised in those patients with pre-operatively preserved active forward elevation. Conclusion:The available evidence suggests that RTSA is a reliable option in older patients with persistent pain and lack of function following MIRCT even without arthritis. However, as outcomes are not significantly worse following failed rotator cuff repair, joint preserving options in the younger age group should be carefully considered in light of the relatively high complication rate associated with RTSA.

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Subacromial balloon spacer massive rotator cuff tear treatment systematic review and meta‐analysis: Patient selection and physical therapy may be keys to outcome success

Sirignano,

Nyland,

Krupp

2024

Knee surg. sports traumatol. arthrosc.

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PurposeSubacromial balloon spacer implantation (SBSI) efficacy for massive rotator cuff tear treatment was evaluated based on perceived shoulder function, active shoulder mobility, pain, complications and research study methodological quality. The purpose was to better discern the efficacy of this device from both surgical and rehabilitative perspectives to improve patient outcomes.MethodsPubMed, EMBASE and Cochrane Library databases were searched (1 January 2010 to 1 June 2024) using ‘balloon spacer’, ‘subacromial spacer’, ‘subacromial balloon spacer’, ‘shoulder spacer’ and ‘inspace’ terms. Pre‐surgery (baseline), 12‐month (12‐m) and 24‐month (24‐m) post‐SBSI mean changes were compared using one‐way ANOVA and Scheffe post hoc tests, and comparative study effect sizes were calculated (p ≤ 0.05).ResultsThis review consists of 27 studies with 894 patients (67.8 ± 5 years of age) and 29.4 ± 17‐month follow‐up. Modified Coleman Methodology Scores (MCMS) revealed fair overall quality (mean = 61.4 ± 11). Constant–Murley scores improved from 34.8 ± 6 (baseline), to 64.2 ± 9 (12‐m) and 67.9 ± 8 (24‐m) (12‐m, 24‐m > baseline, p < 0.001). ASES scores improved from 35.1 ± 14 (baseline), to 83.3 ± 7 (12‐m) and 81.8 ± 5 (24‐m)(12‐m, 24‐m > baseline, p < 0.001). VAS pain scores improved from 6.6 ± 1 (baseline), to 2.6 ± 1 (12‐m) and 2.0 ± 1 (24‐m) (12‐m, 24‐m < baseline, p < 0.001). Flexion increased from 108.5 ± 25° (baseline), to 128.5 ± 30° (12‐m) and 151.2 ± 14° (24‐m) (24‐m > 12‐m, baseline, p = 0.01). Abduction increased from 97.7 ± 24° (baseline) to 116.3 ± 23° (12‐m) and 142.3 ± 15° (24‐m) (24‐m > 12‐m, baseline, p = 0.02). External rotation (ER) in adduction changed from 33.1 ± 7° (baseline) to 32.5 ± 4° (12‐m) and 53.9 ± 9° (24‐m)(24‐m > 12‐m, baseline, p = 0.01). ER at 90° abduction increased from 56.3 ± 3° (baseline) to 83.5 ± 5° (12‐m) and 77.1 ± 4° (24‐m) (24‐m, 12‐m > baseline, p = 0.01). Comparison studies, however, displayed insignificant results with small effect sizes.ConclusionDespite overall fair MCMS scores, at 24‐m post‐SBSI, shoulder function improved and pain decreased. More rigorous comparative studies, however, revealed insignificant findings. Patients with the potential to re‐establish the essential glenohumeral joint force couple that depresses the humeral head on the glenoid fossa and who comply with physical therapy may be more likely to achieve success following SBSI.Level of EvidenceLevel IV.

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Arthroscopic partial repair with versus without biodegradable subacromial spacer for patients with massive rotator cuff tears: a case–control study

Cited by 19 publications

References 22 publications

Subacromial balloon spacer – Where are we now?

Subacromial balloon spacer – Where are we now?

Reverse total shoulder arthroplasty for irreparable rotator cuff tears without arthritis: A systematic review

Subacromial balloon spacer massive rotator cuff tear treatment systematic review and meta‐analysis: Patient selection and physical therapy may be keys to outcome success

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