Biceps Tenotomy Does not Affect the Functional Outcomes of Patients Treated with Spacer Implantation Due to Massive Irreparable Rotator Cuff Tears

Abstract

Background:Lesions of the long head of the biceps (LHB) tendon are frequently associated with massive rotator cuff tears (RCT) and may be responsible for shoulder pain and disability.Objective:This study aimed to evaluate functional outcomes of arthroscopic biodegradable spacer implantation with or without biceps tenotomy as treatment for persistent shoulder dysfunction and pain due to a massive irreparable RCT.Methods:A total of 48 patients were implanted with the subacromial spacer using arthroscopic approach with or without biceps tenotomy. All patients were assessed for up to 12 months post-implantation and 18 patients were assessed for at least 24 months (and a maximum of 40 months). Improvement in shoulder function was assessed using Constant score.Results:Subacromial spacer implantation was performed arthroscopically in 48 patients. The mean total Constant score increased from 36 at baseline to 67 points at 12 months post implantation. Patients who underwent LHB tenotomy in addition to the subacromial spacer presented similar improvement of their shoulder function and score compared to the group that was treated with the spacer alone.Conclusion:Current study demonstrates that spacer implantation in this patient population provides significant improvement in function and decreases the pain. Additional LHB tenotomy did not influence the postoperative results during the follow-up.

Implantable Subacromial Balloon Spacers in Patients With Massive Irreparable Rotator Cuff Tears: A Systematic Review of Clinical, Biomechanical, and Financial Implications

“…Our study results demonstrate that the use of subacromial balloon spacers for the management of patients with irreparable rotator cuff tears results in a significant improvement in the following clinical outcome measures: TCS, 7,25,26,38,3,40,41,44,45,46,47,53 OSS, 26,42,47 and ROM parameters such as mean shoulder abduction, mean shoulder elevation, internal rotation, and external rotation. 26,39,40,42,44,45 Furthermore, the clinical improvements in ASES, TCS, shoulder ROM, and patient satisfaction associated with subacromial balloon spacer use are comparable to those seen after management with other treatments for massive, irreparable rotator cuff tears such as subacromial debridement, 54,55 biceps tenotomy, 56 partial rotator cuff repair, [57][58][59] latissimus dorsi transfer, 60 and reverse total shoulder arthroplasty.…”

“…It is worth noting that a majority of these studies included interventions featuring subacromial balloon implantation in addition to biceps tenotomy and 9.43% (33/350) were performed in conjunction with partial rotator cuff repair; therefore, the true effect of subacromial balloon spacer use alone is not fully elucidated. Maman et al 25 attempted to answer this question, as their study demonstrated no difference in functional outcomes such as TCS following placement of the balloon spacer both with and without biceps tenotomy and Senekovic et al 46 corroborated these findings in a group of 9 patients. Malahias et al 40 and Holschen et al 39 both demonstrated that balloon spacer implantation with concomitant partial rotator cuff repair provided no significant improvement in clinical outcomes compared to balloon spacer placement alone.…”

“…Malahias et al 40 and Holschen et al 39 both demonstrated that balloon spacer implantation with concomitant partial rotator cuff repair provided no significant improvement in clinical outcomes compared to balloon spacer placement alone. In addition, Gervasi et al 7 and Maman et al 25 performed the balloon spacer implantation procedure simply under fluoroscopic guidance with local anesthesia. While such an approach may result in the missed opportunity to treat additional pathologies such as bursitis and biceps tendinitis, 39 the potential for decreased anesthesia requirement and reduced operative time 7,25,41 makes the subacromial balloon spacer a less-invasive but equally effective option for the surgical management of massive, irreparable rotator cuff tears.…”

“…24 Reported advantages of this device are its minimal technical demands and shorter operative duration, 7,24,25 evidence of expedited postoperative shoulder mobility, 26 and improved postoperative clinical function scores, such as Total Constant Score (TCS), American Shoulder and Elbow Surgeons (ASES) score, and Oxford Shoulder Score (OSS) in patients, [27][28][29] and the ability to implant the device under fluoroscopic guidance without general anesthesia in those patients with medical contraindications. 7,25 Recent systematic reviews by Moon et al 29 and Stewart et al 30 demonstrated improvements in patient satisfaction and clinical outcomes such as TCS and ASES in patients managed with subacromial balloon spacers. However, there is limited research regarding the potential biomechanical and clinical advantages in addition to the cost associated with subacromial balloon spacers in a systematic review.…”

Editorial Commentary: Yet Another Arrow in the Quiver for Surgical Treatment of the Rotator Cuff–Deficient Shoulder: Will It Fly Fast and Far or Fall Short Like Other Options Have?

“…The study designs were dissimilar. Maman et al 2 arthroscopically placed 42 ISBs but did not attempt a rotator cuff repair and treated long head biceps pathology appropriately. All followed up at 1 year and 18 (43%) followed up between 24 and 40 months, and results were maintained.…”