Subacromial Balloon Placement Demonstrates No Advantage Over Debridement in the Treatment of Massive Irreparable Rotator Cuff Tears: A Dual-Armed Systematic Review and Meta-analysis of Over 1000 Patients

PurposeThe aim of this study was to analyse clinical, functional and shoulder kinematics results using subacromial balloon spacer in nonreparable massive rotator cuff tears. Subacromial balloon spacer was hypothesised to improve shoulder kinematics and increases clinical and functional outcomes scores in nonreparable massive rotator cuff tears.MethodsThis is a prospective study in massive rotator cuff tears. From October 2021 to October 2022, a total of 127 shoulders suffering massive rotator cuff tears were initially evaluated. All patients were evaluated preoperatively, at 6 and 12 months. Patients' patient‐reported outcome measures (PROM) subjective values using visual analogue scale (VAS) and the Spanish Western Ontario Rotator Cuff Index (WORC) version were analysed. We also evaluated objective outcomes: constant score, range of movement and kinematic shoulder analysis (isokinetic test to evaluate internal and external rotation forces). Statistical analysis was conducted using SPSS software; continuous variables were presented as means and standard deviations (SDs).ResultsSeventeen nonrepairable massive rotator cuff tears were finally included. Three patients required reverse shoulder arthroplasty before 6 months postoperative. After 1‐year follow‐up, objective and subjective (PROM) outcome scores and isokinetic measurements improved in 13 patients. Preoperative VAS improved from 6.5 ± 2.1 to 2 ± 1.9 points on average at 1‐year follow‐up and WORC index from 1603 ± 217.3 to 699 ± 361.6. Constant score from 42.1 ± 13.1 on average and at 1‐year follow‐up increased to 60.8 ± 14.7. Range of movement also improved in elevation 122.2 ± 39.3 to 166.9 ± 25.8, abduction 120.3 ± 38.6 to 134.6 ± 21.1, external rotation 30.3 ± 19.7 to 86.1 ± 13.8 and internal rotation L4–T12 on average at 1‐year follow‐up. Isokinetic evaluation showed functional improvement 1 year after implantation. Both internal and external rotation improved compared with their healthy shoulder. External rotation improved from 30.3° ± 19.7° preoperatively to 86.1° ± 13.8° (43.7% in the isokinetic study) and internal rotation from L4 preoperatively to L1 (49.8% in isokinetic study) on average.ConclusionAmong the different alternatives for irreparable rotator cuff injuries surgical treatment, subacromial balloon spacer is an effective alternative in selected patients, both in terms of clinical‐functional improvement and short‐term isokinetic results.Level of EvidenceLevel II

Subacromial balloon spacer improves isokinetic performance in patients with massive irreparable rotator cuff tear

Luengo‐Alonso,

Rueda,

Martínez‐Catalán

et al. 2024

Shoulder balloon spacer for massive irreparable rotator cuff tears results in significant improvements

Savarese,

Aicale,

Romeo

et al. 2024

PurposeThe aim of the present study was to assess the effectiveness of balloon implantation in patients with irreparable supraspinatus tears alone or in combination with other rotator cuff (RC) tendon tears and the effect of several covariables, such as age, gender, status of the long head biceps, with or without tendon repair and regardless the number of tendon involved.MethodsPatients enrolled from ‘San Carlo’ Hospital of Potenza (Italy, IT), from January 2012 to September 2014, underwent arthroscopic implantation of shoulder balloon by a single surgeon, and followed for 3 years. The American Shoulder and Elbow Surgeons (ASES) and Constant score (CS) were administered pre‐, post‐operatively at 12 months, and then annually. Patients were classified on the basis of the number of tendons involved in the tears and treatment performed, considering the reparability of the tendons themselves. Gleno‐humeral joint osteoarthrosis (OA) was evaluated through shoulder radiographs and classified according to the Samilson–Prieto classification, at the first examination and at the final follow‐up. Statistical improvements were evaluated using a variance model (least‐squares means) and a T distribution test for the evaluation between different treatment groups.ResultsA total of 61 procedures were performed, and eight patients were lost during follow‐up. The mean baseline CS was 30.2 ± 15.4 with statistically significant improvement, respectively, at 1‐, 2‐ and 3‐year follow‐up to 69.3 ± 4.2, 74.6 ± 3.6 and 69.7 ± 5.1 respectively. ASES score at baseline was 22.5 ± 10.9, with a statistically significant improvement to 69.7 ± 9.2, 68 ± 17.8 and 71.2 ± 16.6 at 1‐, 2‐ and 3‐year follow‐up, respectively. Tenotomy or absence of long head biceps at presentation did not influence results (n.s.), with no difference according to gender and age. At final follow‐up, 24 patients (43.9%) showed progression of glenohumeral OA. One patient required secondary surgery for shoulder replacement after 18 months for persistent pain and one patient required implant removal following post‐operative laser treatment.ConclusionArthroscopic rotator cuff tears repair with subacromial spacer balloon implantation showed statistically significant clinical and functional improvement at 3‐year follow‐up. Patients treated with combined partial repair and subacromial spacer balloon implantation experienced good results independent of gender, age, type of tear and long‐head biceps tendon status. The risks related to this procedure appear to be minimal.Level of EvidenceLevel IV.

Recentering the humeral head does not necessarily improve glenohumeral abduction: A cadaveric biomechanical study

Hu,

Li,

et al. 2024

PurposeTo explore if recentering the humeral head could improve shoulder abduction in shoulders with irreparable massive rotator cuff tears (IMRCTs).MethodsNine fresh‐frozen cadaveric shoulders were used to simulate the intact condition and IMRCTs as controls. Four ‘recenter’ interventions were then sequentially applied: subacromial interposition (SI) using 4‐ and 8‐mm spacers and superior capsule reconstruction (SCR) using two‐ and four‐layer fascia lata grafts. Dynamic biomechanical experiments were performed for each condition. The primary outcomes were glenohumeral abduction angle (GAA). The secondary outcomes were acromiohumeral distance (AHD) and subacromial contact pressure.ResultsIn the intact condition, the GAA was significantly greater compared to the IMRCT condition at most deltoid force levels (p < 0.05 for all except at 80 N). IMRCT significantly increased maximum contact pressure (MCP) compared to intact (Δ +0.09 MPa, p = 0.029). For recentering interventions, neither SI nor SCR improved GAA (p > 0.05). The 8‐mm spacer and four‐layer SCR condition significantly increased MCP compared to the intact condition (Δ +0.22 MPa, p = 0.048, Δ +0.24 MPa, p = 0.012, respectively).ConclusionBoth SCR and SI could effectively recenter the humeral head, but neither technique improved shoulder abduction, with both even significantly increasing subacromial contact pressures. These findings suggest that surgical goals focusing solely on recentering humeral head may need re‐evaluation, particularly, for patients with high functional demands on shoulder abduction.Level of EvidenceN/A.