Skip to main content
Erschienen in: European Journal of Orthopaedic Surgery & Traumatology 3/2013

01.04.2013 | Original Article

Prospective clinical study of a novel biodegradable sub-acromial spacer in treatment of massive irreparable rotator cuff tears

verfasst von: Vladimir Senekovic, Boris Poberaj, Ladislav Kovacic, Martin Mikek, Eliyahu Adar, Assaf Dekel

Erschienen in: European Journal of Orthopaedic Surgery & Traumatology | Ausgabe 3/2013

Einloggen, um Zugang zu erhalten

Abstract

Purpose

The purposes of this prospective non-randomized study were to confirm the feasibility of the biodegradable sub-acromial spacer (InSpace™) implantation in patients with massive irreparable rotator cuff tear and to determine the safety profile and functional results 3 years post-implantation.

Methods

Twenty patients were implanted with the InSpace™ device and assessed up to 3 years of post-implantation. Improvement in shoulder function was assessed using Constant score, while ease of use of the system was recorded by surgeons as were device-related adverse events.

Results

Twenty patients were available for assessment. Implantation was performed arthroscopically in all patients, and a range of deployment time was 2–20 min. The mean total Constant score increased from 33.4 to 65.4 points at 3 years. There was an improvement of 6.4 points in subjective pain score which commenced at 1 week post-operatively and was sustained until 3 years of follow-up. Also activities of daily living and motions commenced improvement by 9.4 and 7.7 points, respectively. Improvement in power was only evident at 18 months of follow-up but was sustained at 3 years.

Conclusions

Arthroscopic deployment of a co-polymer biodegradable spacer (balloon) into the sub-acromial space for an irreparable rotator cuff tear was found to be low-risk and simple procedure associated with improvement in shoulder function and low rate of complications.

Level of evidence

IV; therapeutic case series
Literatur
1.
Zurück zum Zitat Tonino PM, Gerber C, Itoi E, Porcellini G, Sonnabend D, Walch G (2009) Complex shoulder disorders: evaluation and treatment. J Am Acad Orthop Surg 17:125–136PubMed Tonino PM, Gerber C, Itoi E, Porcellini G, Sonnabend D, Walch G (2009) Complex shoulder disorders: evaluation and treatment. J Am Acad Orthop Surg 17:125–136PubMed
2.
Zurück zum Zitat Cofield RH (1985) Rotator cuff disease of the shoulder. J Bone Joint Surg Am 67(6):974–979PubMed Cofield RH (1985) Rotator cuff disease of the shoulder. J Bone Joint Surg Am 67(6):974–979PubMed
3.
Zurück zum Zitat Matthews TJ, Hand GC, Rees JL, Athanasou NA, Carr AJ (2006) Pathology of the torn rotator cuff tendon. Reduction in potential for repair as the tear size increases. J Bone Joint Surg Br 88:489–495PubMedCrossRef Matthews TJ, Hand GC, Rees JL, Athanasou NA, Carr AJ (2006) Pathology of the torn rotator cuff tendon. Reduction in potential for repair as the tear size increases. J Bone Joint Surg Br 88:489–495PubMedCrossRef
4.
Zurück zum Zitat Coleman SH, Fealy S, Ehteshami JR et al (2003) Chronic rotator cuff injury and repair model in sheep. J Bone Joint Surg Am 85:2391–2402PubMed Coleman SH, Fealy S, Ehteshami JR et al (2003) Chronic rotator cuff injury and repair model in sheep. J Bone Joint Surg Am 85:2391–2402PubMed
5.
Zurück zum Zitat Liu X, Manzano G, Kim HT, Feeley BT (2011) A rat model of massive rotator cuff tears. J Orthop Res 29:588–595PubMedCrossRef Liu X, Manzano G, Kim HT, Feeley BT (2011) A rat model of massive rotator cuff tears. J Orthop Res 29:588–595PubMedCrossRef
6.
Zurück zum Zitat Goutallier D, Postel JM, Bemageau J et al (1994) Fatty muscle degeneration in cuff ruptures. Pre- and postoperative evaluation by CT scan. Clin Orthop Rel Res 304:78–83 Goutallier D, Postel JM, Bemageau J et al (1994) Fatty muscle degeneration in cuff ruptures. Pre- and postoperative evaluation by CT scan. Clin Orthop Rel Res 304:78–83
7.
Zurück zum Zitat Encalada-Diaz I, Cole BJ, MacGillivray JD, Ruiz-Suarez M, Kercher JS, Friel NA, Valero-Gonzalez F (2011) Rotator cuff repair augmentation using a novel polycarbonate polyurethane patch: preliminary results at 12 months follow-up. J Shoulder Elbow Surg 20:788–794PubMedCrossRef Encalada-Diaz I, Cole BJ, MacGillivray JD, Ruiz-Suarez M, Kercher JS, Friel NA, Valero-Gonzalez F (2011) Rotator cuff repair augmentation using a novel polycarbonate polyurethane patch: preliminary results at 12 months follow-up. J Shoulder Elbow Surg 20:788–794PubMedCrossRef
8.
Zurück zum Zitat Moser M, Jablonski MV, Horodyski M, Wright TW (2007) Functional outcome of surgically treated massive rotator cuff tears: a comparison of complete repair, partial repair and debridement. Orthopedics 30:479–482PubMed Moser M, Jablonski MV, Horodyski M, Wright TW (2007) Functional outcome of surgically treated massive rotator cuff tears: a comparison of complete repair, partial repair and debridement. Orthopedics 30:479–482PubMed
9.
Zurück zum Zitat Aurora A, McCarron J, Ianotti J, Derwin K (2007) Commercially available extracellular matrix materials for rotator cuff repairs: state of the art and future trends. J Should Elbow Surg 16(5 Suppl):S171–S178CrossRef Aurora A, McCarron J, Ianotti J, Derwin K (2007) Commercially available extracellular matrix materials for rotator cuff repairs: state of the art and future trends. J Should Elbow Surg 16(5 Suppl):S171–S178CrossRef
10.
Zurück zum Zitat Goldberg SS, Bell JE, Kim HJ, Bak SF, Levine WM, Bigilani LY (2008) Hemiarthroplasty for the rotator cuff-deficient shoulder. J Bone Joint Surg Am 90:554–559PubMedCrossRef Goldberg SS, Bell JE, Kim HJ, Bak SF, Levine WM, Bigilani LY (2008) Hemiarthroplasty for the rotator cuff-deficient shoulder. J Bone Joint Surg Am 90:554–559PubMedCrossRef
12.
Zurück zum Zitat Constant CR, Murley AH (1987) A clinical method of functional assessment of the shoulder. Clin Orthop Rel Res 214:160–164 Constant CR, Murley AH (1987) A clinical method of functional assessment of the shoulder. Clin Orthop Rel Res 214:160–164
13.
Zurück zum Zitat Boes MT, McCann PD, Dines DM (2006) Diagnosis and management of massive rotator cuff tears: the surgeon’s dilemma. Instr Course Lect 55:45–57PubMed Boes MT, McCann PD, Dines DM (2006) Diagnosis and management of massive rotator cuff tears: the surgeon’s dilemma. Instr Course Lect 55:45–57PubMed
14.
Zurück zum Zitat Al-Shawi A, Badge R, Bunker T (2008) The detection of full thickness rotator cuff tears using ultrasound. J Bone Joint Surg Br 90:889–892PubMedCrossRef Al-Shawi A, Badge R, Bunker T (2008) The detection of full thickness rotator cuff tears using ultrasound. J Bone Joint Surg Br 90:889–892PubMedCrossRef
15.
Zurück zum Zitat Morag Y, Jacobson JA, Miller B, De Maeseneer M, Girish G, Jamadar D (2006) MR imaging of rotator cuff injury: what the clinician needs to know. Radiographics 26:1045–1065PubMedCrossRef Morag Y, Jacobson JA, Miller B, De Maeseneer M, Girish G, Jamadar D (2006) MR imaging of rotator cuff injury: what the clinician needs to know. Radiographics 26:1045–1065PubMedCrossRef
16.
Zurück zum Zitat Burks CA, Bundy K, Fotuhi P, Alt E (2006) Characterization of 75:25 poly(L-lactide-co-e-caprolactone) thin films for the endoluminal delivery of adipose-derived stem cells to abdominal aortic aneurysms. Tissue Eng 12:2591–2600. doi:10.1089/ten.2006.12.2591 PubMedCrossRef Burks CA, Bundy K, Fotuhi P, Alt E (2006) Characterization of 75:25 poly(L-lactide-co-e-caprolactone) thin films for the endoluminal delivery of adipose-derived stem cells to abdominal aortic aneurysms. Tissue Eng 12:2591–2600. doi:10.​1089/​ten.​2006.​12.​2591 PubMedCrossRef
17.
Zurück zum Zitat Parsons IM, Apreleva M, Fu FH, Woo SL (2002) The effect of rotator cuff tears on reaction forces at the glenohumeral joint. J Orthop Res 20:439–446PubMedCrossRef Parsons IM, Apreleva M, Fu FH, Woo SL (2002) The effect of rotator cuff tears on reaction forces at the glenohumeral joint. J Orthop Res 20:439–446PubMedCrossRef
18.
Zurück zum Zitat Kedgley AE, MacKenzie GA, Ferreira LM, Johnson JA, Faber KJ (2007) In vitro kinematics of the shoulder following rotator cuff injury. Clin Biomech (Bristol, Avon) 22:1068–1073 Kedgley AE, MacKenzie GA, Ferreira LM, Johnson JA, Faber KJ (2007) In vitro kinematics of the shoulder following rotator cuff injury. Clin Biomech (Bristol, Avon) 22:1068–1073
19.
Zurück zum Zitat Mulieri P, Dunning P, Klein S, Pupello D, Frankle M (2010) Reverse shoulder arthroplasty for the treatment of irreparable rotator cuff tear without glenohumeral arthritis. J Bone Joint Surg Br 92:2544–2556. doi:10.2106/JBJS.I.00912 CrossRef Mulieri P, Dunning P, Klein S, Pupello D, Frankle M (2010) Reverse shoulder arthroplasty for the treatment of irreparable rotator cuff tear without glenohumeral arthritis. J Bone Joint Surg Br 92:2544–2556. doi:10.​2106/​JBJS.​I.​00912 CrossRef
20.
Zurück zum Zitat Li S, Sun B, Li X, Yuan X (2008) Characterization of electrospun core/shell poly (vinyl pyrrolidone)/poly (L-lactide-co-epsilon-caprolactone) fibrous membranes and their cytocompatibility in vitro. J Biomater Sci Polym Ed 19:245–258PubMedCrossRef Li S, Sun B, Li X, Yuan X (2008) Characterization of electrospun core/shell poly (vinyl pyrrolidone)/poly (L-lactide-co-epsilon-caprolactone) fibrous membranes and their cytocompatibility in vitro. J Biomater Sci Polym Ed 19:245–258PubMedCrossRef
21.
Zurück zum Zitat Liem D, Lengers N, Dedy N, Poetzl W, Steinbeck J, Marquardt B (2008) Arthroscopic debridement of massive irreparable rotator cuff tears. Arthroscopy 24:743–748PubMedCrossRef Liem D, Lengers N, Dedy N, Poetzl W, Steinbeck J, Marquardt B (2008) Arthroscopic debridement of massive irreparable rotator cuff tears. Arthroscopy 24:743–748PubMedCrossRef
22.
Zurück zum Zitat Katolik LY, Romeo AA, Cole BJ, Verma NN (2005) Normalization of the Constant score. J Should Elbow Surg 14:279–285CrossRef Katolik LY, Romeo AA, Cole BJ, Verma NN (2005) Normalization of the Constant score. J Should Elbow Surg 14:279–285CrossRef
Metadaten
Titel
Prospective clinical study of a novel biodegradable sub-acromial spacer in treatment of massive irreparable rotator cuff tears
verfasst von
Vladimir Senekovic
Boris Poberaj
Ladislav Kovacic
Martin Mikek
Eliyahu Adar
Assaf Dekel
Publikationsdatum
01.04.2013
Verlag
Springer-Verlag
Erschienen in
European Journal of Orthopaedic Surgery & Traumatology / Ausgabe 3/2013
Print ISSN: 1633-8065
Elektronische ISSN: 1432-1068
DOI
https://doi.org/10.1007/s00590-012-0981-4

Weitere Artikel der Ausgabe 3/2013

European Journal of Orthopaedic Surgery & Traumatology 3/2013 Zur Ausgabe

Arthropedia

Grundlagenwissen der Arthroskopie und Gelenkchirurgie. Erweitert durch Fallbeispiele, Videos und Abbildungen. 
» Jetzt entdecken

Update Orthopädie und Unfallchirurgie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.