Comparing Clinical Outcomes After Subacromial Spacer Insertion Versus Other Reconstruction Methods in the Treatment of Irreparable Massive Rotator Cuff Tears

Abstract

Background: Previous studies on subacromial spacer (SAS) insertion have been limited to case series that did not compare the effectiveness of this technique with other techniques. Hypothesis: Outcomes after SAS insertion for the treatment of irreparable massive rotator cuff tears (IMRCTs) will be similar to those of other techniques. Study Design: Cohort study; Level of evidence, 3. Methods: This retrospective study was based on data collected from patients who underwent correction of IMRCTs between January 2010 and October 2017. Group 1 patients (n = 17) received SAS insertion with or without partial repair; group 2 patients (n = 36) were treated with other techniques (isolated partial repairs or bridging grafts). Preoperative tear size and global fatty degeneration index values were evaluated. Range of motion, visual analog scale for pain, American Shoulder and Elbow Surgeons (ASES) score, Constant score, Simple Shoulder Test (SST), Disabilities of the Arm, Shoulder and Hand score, and acromiohumeral distance (AHD) were assessed preoperatively and at final follow-up at least 2 years after the surgery (range, 24-60 months). In both groups, ultrasonographic examination was performed at 3 and 6 months postoperatively, and magnetic resonance imaging (MRI) was performed at 1 year. Results: Tear size and preoperative global fatty degeneration index were not significantly different between the groups (all P > .05). There were no differences in functional scores between the groups at final follow-up (all P > .05). AHD was maintained at final follow-up in group 1 (mean ± SD: 6.2 ± 2.1 mm [postoperatively] vs 6.7 ± 2.3 mm [final follow-up]; P = .678), and there was no difference compared with group 2 (7.2 ± 3.2 mm; P = .244). Patients with retears in group 2 (23 of 36, 63.9%) had lower ASES ( P = .041) and SST ( P = .027) scores at final follow-up when compared with patients in group 1. Six patients (35.3%) in group 1 had partial repairs; these patients had better external rotation at 90° ( P = .047), better SST scores ( P = .036), and higher AHDs at final follow-up ( P = .046) than those in group 1 who had no repair. Three patients (50%) showed retears of partially repaired tendons on MRI. Of 13 patients (76.5%) in group 1 with postoperative MRI, 12 (92.3%) showed fibrotic tissue in the subacromial space not seen preoperatively. Conclusion: There was no difference in outcomes between SAS and the other reconstruction methods for treating IMRCTs. However, given the high retear rate associated with other techniques and poor functional outcomes after retear, SAS insertion could be a viable option for treating IMRCTs.

Subacromial balloon spacer – Where are we now?

“…54 Another study also concluded that patients with a partial repair and the balloon fared better than those with balloon only intervention. 50 In total 513 patients have been analysed as part of clinical studies investigating the outcome of the subacromial balloon spacer; however, there were 619 patients recruited and included in the studies. Only 83% of patients initially meeting the inclusion criteria were analysed, the majority of the rest were either lost to follow-up or withdrew.…”

“…Further complications include new-onset pseudoparalysis in two patients following balloon insertion without addressing the associated subscapularis tear. 50 Although the whole biomechanical theory of the InSpace™ balloon is to depress the humeral head inferiorly, thereby recreating native glenohumeral joint kinematics, few studies have analysed the radiographic evidence of this. One of the studies that used plain film radiographs post-operatively concluded that there was no significant effect of the balloon spacer on the upper migration index (UMI) with a pre-op UMI of 1.15 and a post-op of 1.16 52 (UMI < 1.25 is suggestive of severe proximal migration of the humeral head).…”

“…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.…”

Poor Results After Arthroscopic Treatment of Irreparable Rotator Cuff Tears Using a Subacromial Balloon Spacer

“…The group in which a procedure other than BSA (biceps augmentation, patch graft, or partial repair alone) was conducted had a higher retear rate (63.9) but similar clinical and radiological results. 27 Bakti et al 28 reported improvements in HRQoL. Physical dimension improved earlier but was nonsignificant at the final follow-up, contrary to mental dimension, which improved markedly only at the final follow-up.…”

Multiple surgical treatment comparisons for irreparable rotator cuff tears: A network meta-analysis

“…We excluded 398 duplicate articles and further 2017 articles after reviewing the titles and abstracts. After screening the remaining 459 full papers, we included 17 [15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31] in our network meta-analysis. Figure 1 shows a flowchart of the sample selection procedure.…”