Subacromial balloon spacer – Where are we now?

Abstract

Introduction: Rotator cuff tears are a common cause of disability and pain. The ideal treatment for truly irreparable rotator cuffs is still debated, and one recent surgical advance is the development of the subacromial balloon spacer. This review aims to clarify the current evidence and indications for this device. Methods: A comprehensive literature search was undertaken using the MeSH search terms combining "balloon spacer" and "irreparable cuff tear". A total of 20 studies using the balloon spacer as a treatment modality in more than two patients, were analysed. Results: A total of 513 patients were analysed, representing 83% of those initially identified as meeting the inclusion criteria. The majority of studies recommended the device, with only four suggesting it was not recommended based on their results. Notable bias was present in the studies analysed, and there were no papers providing greater than level III evidence. Conclusion:The subacromial balloon spacer is one possible treatment option for older, low-demand patients with a full thickness rotator cuff tear involving only the supraspinatus tendon, who also have no arthritis and have preserved active elevation beyond 90 . However, the results of two large randomised prospective trials are awaited to provide satisfactory evidence regarding the use of the balloon spacer.

Effective Management of Bilateral Massive Irreparable Rotator Cuff Tears through Implantation of Subacromial Balloon Spacers

“…The subacromial balloon spacer has been introduced as a novel surgical technique in shoulder surgery with great therapeutic potential in the domain of irreparable rotator cuff tears [ 9 ]. This device is made from a biodegradable and bioabsorbable polymer, with properties that ensure both the elasticity and strength required to be introduced in the subacromial space and alleviate any concurrent impingement [ 10 , 11 , 12 , 13 ]. Evaluation of the safety profile of the device showed no evidence of systemic toxicity or chronic body reaction after its introduction into the body [ 10 ].…”

“…This device is made from a biodegradable and bioabsorbable polymer, with properties that ensure both the elasticity and strength required to be introduced in the subacromial space and alleviate any concurrent impingement [ 10 , 11 , 12 , 13 ]. Evaluation of the safety profile of the device showed no evidence of systemic toxicity or chronic body reaction after its introduction into the body [ 10 ]. As a result, and over the recent years, the balloon has been considered a viable and safe option for many rotator cuff patients, whose presentation fits the indications and contraindications of its placement.…”

Outcomes of arthroscopic tuberoplasty for symptomatic irreparable rotator cuff tendon tear without pseudoparalysis

“…Several studies published recently have shown favorable results. 18 , 22 , 24 Notably, Stewart et al 18 conducted a systematic review that included 12 studies for final analysis showing improvements in mean Constant Scores from 18.5 to 49.6 at an average of 22.9 months after implantation. These studies also describe similarly low rates of complications, revision surgeries, or clinical failures.…”

The changing landscape of rotator cuff surgery

“…12 Insertion of a biodegradable balloon in the subacromial space to reduce acromio-humeral contact and aid deltoid function has also been explored. 13 Such "disruptive" technologies seek to lower the surgical risks and morbidities associated with tendon transfers which require a more extensive surgical dissection. 14 Ever-increasing management options for the challenging cuff notably include Reverse Shoulder Arthroplasty (RSA).…”