Early promising outcome following arthroscopic implantation of the subacromial balloon spacer for treating massive rotator cuff tear

Abstract

Our results suggest that arthroscopic implantation of a biodegradable balloon spacer in the subacromial space significantly reduces pain and improves activities of daily living in patients with massive RCT during 1 year of follow-up. The specific contribution of the balloon with respect to improved clinical outcome needs further study, ideally in a randomized controlled trial.

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

“…Risk of bias assessment using the MINORS criteria is displayed in Table 2 [38][39][40][41][42][43][44][45][46][47] and Figure 2, and design characteristics of selected studies are included in Tables 3 and 4. [38][39][40][41][42][43][44][45][46][47] Two studies by Piekaar et al 1,42 were retrieved, which included clinical results from the same group at 1 and 3 years of follow-up after implantation of a subacromial balloon spacer. Only the results from Piekaar et al 42 reporting 3-year follow-up were included in the results and statistical analysis of the present study.…”

“…Poly(L-lactide-co-ε-caprolactone) is not known to have toxic properties, 64 and review of the literature demonstrates very few complications associated with implantation of the subacromial balloon spacer in humans. 1,7,26,[38][39][40]42,[45][46][47][48]5 3 A rodent study by Ramot et al 64 was notable for development of a fibrosarcoma at the subcutaneous implantation site of 1 rodent. In a 5-year follow-up study, Senekovic et al 46 noted 2 patients with synovitis associated with slight deterioration in shoulder function after implantation; however, there was no baseline imaging for these patients, and it was not felt to be possible to determine if these were truly a device-related complication.…”

How Much Will High Tension Adversely Affect Rotator Cuff Repair Integrity?

“…Based on the published literature, 1.4 points is the minimal clinically important difference (MCID) for VAS, 11.1 for ASES, 10.83 points for DASH, and 11 points for Constant-Murley. [11][12][13] For the radiographic evaluation, the critical shoulder angle (CSA) and acromiohumeral interval (AHI) were measured using a true anteroposterior radiograph. The CSA, the angle between a line connecting the superior and inferior margins of the glenoid and a line drawn from the inferior margin of the glenoid to the lateral border of the acromion, was measured.…”

Mid-term Clinical and Radiological Outcomes of Latissimus Dorsi Tendon Transfer in Massive Rotator Cuff Tears

“…In massive irreparable rotator cuff tears, several treatment options include arthroscopic debridement, partial repair, [1][2][3] superior capsular reconstruction (SCR), [4][5][6] auto-or allograft interposition, 7) balloon spacer arthroplasty, [8][9][10] trapezius transfer, and latissimus dorsi (LD) transfer 11) or reverse total shoulder arthroplasty (RTSA). [12][13][14][15] Arthroscopic debridement provides pain relief by removing the damaged torn rotator cuff tissue.…”

“…Balloon spacer arthroplasty has recently been proposed, and acts by preventing humeral head migration by placing a biodegradable saline-filled spacer between the humeral head and acromion; however, there is no long-term follow-up study to determine the outcome. [8][9][10] Also, RTSA is very effective for irreparable rotator cuff tears in elderly patients, [12][13][14][15] but due to the questionable longevity of RTSA and limited treatment options after failure, this procedure is not an ideal option for young, active patients. In the future, long term follow-up studies that compare different treatment modalities are required, to verify the superiority of a specific procedure and to determine patient specific indications.…”