Subacromial Balloon Spacer for Massive, Irreparable Rotator Cuff Tears Is Associated With Improved Shoulder Function and High Patient Satisfaction

Familiari, Filippo; Nayar, Suresh K.; Russo, Roberto; Gori, Marco De; Ranuccio, Francesco; Mastroianni, Valerio; Giuzio, Ermes; Galasso, Olimpio; Gasparini, Giorgio; McFarland, Edward G.; Srikumaran, Uma

doi:10.1016/j.arthro.2020.09.048

Cited by 49 publications

(44 citation statements)

References 29 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…One interesting finding in the article is that Familiari et al 7 observed that a higher postoperative acromiohumeral interval was predictive of a lower Constant-Murley score at final follow-up. This seems counterintuitive because the balloon spacer is designed to restore a more normal acromiohumeral interval to allow for more normal shoulder kinematics.…”

Section: See Related Article On Page 480mentioning

confidence: 94%

“…Do these results apply to patients in whom a rotator cuff repair has already failed, or does this treatment just work on untouched shoulders? I applaud Familiari et al 7 for helping to answer some questions about balloon spacers, but there are many more questions to answer before we can proceed without caution. The studies about balloons show promise, but we must make sure that we are not burning future bridges and risking outcomes in patients when this treatment does not work.…”

Section: See Related Article On Page 480mentioning

confidence: 99%

“…The article "Subacromial Balloon Spacer for Massive, Irreparable Rotator Cuff Tears Is Associated With Improved Shoulder Function and High Patient Satisfaction" by Familiari, Nayar, Russo, De Gori, Ranuccio, Mastroianni, Giuzio, Gasparini, McFarland, and Srikumarran 7 adds further evidence about this newer and promising technique to address these difficult tears. It is…”

Section: See Related Article On Page 480mentioning

confidence: 99%

“…Although the results are promising for balloon spacers, there is much that is still not known about these devices. The study by Familiari et al 7 includes only patients who had undergone no prior surgical procedures and in whom 6 months of conservative care had failed. Most of the patients with irreparable cuff tears that I treat have undergone at least 1 prior operation for an attempted repair, if not multiple prior operations.…”

Section: See Related Article On Page 480mentioning

confidence: 99%

See 3 more Smart Citations

Editorial Commentary: Balloons for Rotator Cuff Tears: A Viable Treatment or Just a Bunch of Hot Air?

Guevara¹

2021

Arthroscopy: The Journal of Arthroscopic & Related Surgery

View full text Add to dashboard Cite

Rotator cuff tears are very common. They can be either traumatic or degenerative in nature. Many tears can be successfully treated nonoperatively with physical therapy or home exercises. For patients in whom conservative measures fail, there are a variety of ways to repair the rotator cuff. Despite our advances in knowledge about rotator cuff tears, improved technology, and advanced repair techniques, failure rates after surgery are still high. Large tears that are deemed irreparable can be treated with partial repair, debridement, tendon transfers such as a latissimus dorsi transfer or lower trapezius transfer, biceps tenotomy or tenodesis, superior capsular reconstruction, bridge grafting, or even arthroplasty options such as a hemiarthroplasty or reverse total shoulder arthroplasty. No technique has proved vastly superior to another, and there are many advantages and disadvantages of each surgical procedure. Add balloon spacer implantation to that list. A surgeon can now place a subacromial balloon spacer to help improve functional outcomes and reduce pain in patients with irreparable rotator cuff tears. Studies have shown promising results, with improvements in strength and range of motion, as well as reductions in pain. Outcomes have only been studied in the short term, so much is still unknown about the full effects of this treatment. More studies are needed to find out whether the results persist into the long term and to confirm that complications do not arise that may complicate future procedures such as a reverse total shoulder arthroplasty.

show abstract

Section: See Related Article On Page 480mentioning

confidence: 94%

Section: See Related Article On Page 480mentioning

confidence: 99%

Section: See Related Article On Page 480mentioning

confidence: 99%

Section: See Related Article On Page 480mentioning

confidence: 99%

See 2 more Smart Citations

Editorial Commentary: Balloons for Rotator Cuff Tears: A Viable Treatment or Just a Bunch of Hot Air?

Guevara¹

2021

Arthroscopy: The Journal of Arthroscopic & Related Surgery

View full text Add to dashboard Cite

show abstract

“…4,5 Another option is subacromial balloon spacer, 6,7 which involves arthroscopic deployment of a saline solutionefilled biodegradable spacer and has been shown to re-center the humeral head and improve kinematics. 8,9 This device has been used in Europe for over a decade 6,10,11 but has yet to be approved for use in the United States. There is also the option of reverse shoulder arthroplasty, which has revolutionized the treatment of massive rotator cuff tears accompanied by dysfunction with or without glenohumeral arthritis.…”

Section: See Related Article On Page 402mentioning

confidence: 99%

Editorial Commentary: Superior Capsular Reconstruction Works Biomechanically but Should Be Used Selectively for Genuinely Irreparable Tears

Hasan¹

2021

Arthroscopy: The Journal of Arthroscopic & Related Surgery

View full text Add to dashboard Cite

Superior capsular reconstruction (SCR) has undergone extensive biomechanical and clinical study. Systematic review of biomechanical studies has shown that SCR functions to depress the humeral head and improve the glenohumeral register, which provides proof of concept. Clinical studies have shown the short-term effectiveness of SCR, but this is influenced by graft type and thickness, as well as surgical technique. These studies are mostly flawed because followup is brief, postoperative imaging is often lacking, and the results may not be generalizable. Multiple systematic reviews pooling the results of these various clinical studies have mostly produced diluted conclusions that are not clinically helpful. To date, there is a dearth of comparative studies to help guide the selection of SCR over other treatment options such as subacromial balloon spacer, partial repair with or without augmentation, tendon transfer, reverse shoulder arthroplasty, or even continued nonoperative care. Additionally, SCR is a salvage operation rather than an expedient alternative to careful mobilization of a rotator cuff tear for primary repair. Ultimately, large-scale, long-term imaging-based comparative clinical studies, rather than additional systematic clinical or biomechanical reviews, must provide the evidence needed to determine the precise indications and optimal technique for SCR.

show abstract

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.

View full text Add to dashboard Cite

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.

show abstract

Subacromial Balloon Spacer for Massive, Irreparable Rotator Cuff Tears Is Associated With Improved Shoulder Function and High Patient Satisfaction

Cited by 49 publications

References 29 publications

Editorial Commentary: Balloons for Rotator Cuff Tears: A Viable Treatment or Just a Bunch of Hot Air?

Editorial Commentary: Balloons for Rotator Cuff Tears: A Viable Treatment or Just a Bunch of Hot Air?

Editorial Commentary: Superior Capsular Reconstruction Works Biomechanically but Should Be Used Selectively for Genuinely Irreparable Tears

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

Contact Info

Product

Resources

About