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Current Reviews in Musculoskeletal Medicine

Erschienen in:

13.07.2020 | Surgical Management of Massive Irreparable Cuff Tears (J Sanchez-Sotelo, Section Editor)

Subacromial Balloon Spacer Implantation

verfasst von: Melissa A. Wright, Joseph A. Abboud, Anand M. Murthi

Erschienen in: Current Reviews in Musculoskeletal Medicine | Ausgabe 5/2020

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Abstract

Purpose of Review

Massive irreparable rotator cuff tears present a treatment challenge for the orthopedic surgeon. There is no gold standard among numerous treatment options including nonoperative management, partial repair, debridement, superior capsular reconstruction, and reverse shoulder arthroplasty. In recent years, yet another option, an implantable biodegradable subacromial balloon spacer has become available with promising early results.

Recent Findings

Biomechanical studies have demonstrated that the balloon spacer effectively restores the normal humeral head position and glenohumeral joint mechanics. This device has been used in Europe since 2012 with promising clinical results. Most of the studies on this implantable balloon represent single surgeon uncontrolled case series with small numbers of patients, but they report improvements in pain and function following spacer placement, with the longest term studies reporting maintenance of improvements for up to 5 years. Certain studies have shown a benefit when the procedure is done in isolation as well as in combination with other arthroscopic procedures, such as partial rotator cuff repair.

Summary

The balloon subacromial spacer is a promising new device that can be used in the treatment of patients with massive, irreparable rotator cuff tears. In our experience, patients without arthritis who have active forward elevation over 90 degrees and an intact subscapularis have the best chance of a good outcome. We recommend performing the procedure arthroscopically along with any other indicated procedures including debridement, partial repair, and biceps tenotomy or tenodesis. High-quality long-term studies are needed to better define the indications and outcomes of the implantable balloon spacer in the management of irreparable cuff tears.

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Gervasi E, Maman E, Dekel A, Cautero E. Fluoroscopy-guided biodegradable spacer implantation using local anesthesia: safety and efficacy study in patients with massive rotator cuff tears. Musculoskelet Surg. 2016;100(Suppl 1):19–24. https://doi.org/10.1007/s12306-016-0433-0.CrossRefPubMedPubMedCentral

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• Chevalier Y, Pietschmann MF, Thorwachter C, Chechik O, Adar E, Dekel A, et al. Biodegradable spacer reduces the subacromial pressure: a biomechanical cadaver study. Clin Biomech (Bristol, Avon). 2018;52:41–8. https://doi.org/10.1016/j.clinbiomech.2017.12.008This biomechanical study demonstrated reduced peak pressures in the subacromial space throughout range of motion after implantation of the balloon spacer laying the foundation for how the spacer can improve glenohumeral biomechanics and potentially protect the rotator cuff.CrossRef

17.

•• Lobao MH, Canham RB, Melvani RT, Abboud JA, Parks BG, Murthi AM. Biomechanics of biodegradable subacromial balloon spacer for irreparable superior rotator cuff tears: study of a cadaveric model. J Bone Joint Surg Am. 2019;101(11):e49. https://doi.org/10.2106/JBJS.18.00850This study used a dynamic cadaveric shoulder model and showed that the implantable balloon restored glenohumeral contact pressures, lowered the humeral head, and increased the deltoid load, all of which may contribute to normalizing the biomechanics of the shoulder.CrossRefPubMed

18.

Singh S, Reeves J, Langohr GDG, Johnson JA, Athwal GS. The effect of the subacromial balloon spacer on humeral head translation in the treatment of massive, irreparable rotator cuff tears: a biomechanical assessment. J Shoulder Elb Surg. 2019;28(10):1841–7. https://doi.org/10.1016/j.jse.2019.03.036.CrossRef

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22.

• Deranlot J, Herisson O, Nourissat G, Zbili D, Werthel JD, Vigan M, et al. Arthroscopic subacromial spacer implantation in patients with massive irreparable rotator cuff tears: clinical and radiographic results of 39 retrospective cases. Arthroscopy. 2017;33(9):1639–44. https://doi.org/10.1016/j.arthro.2017.03.029Series of 39 patients with minimum 1-year follow-up who underwent balloon implantation. Results included improved functional and pain scores, as well as improved range of motion and maintenance of Hamada stage on radiographs.CrossRefPubMed

23.

Maman E, Safran O, Beyth S, Mozes G, Dekel A, Michael B, et al. Biceps tenotomy does not affect the functional outcomes of patients treated with spacer implantation due to massive irreparable rotator cuff tears. Open Orthop J. 2017;11:1577–84. https://doi.org/10.2174/1874325001711011577.CrossRefPubMedPubMedCentral

24.

Ricci M, Vecchini E, Bonfante E, Micheloni GM, Berti M, Schenal G, et al. A clinical and radiological study of biodegradable subacromial spacer in the treatment of massive irreparable rotator cuff tears. Acta Biomed. 2017;88(4S):75–80. https://doi.org/10.23750/abm.v88i4-S.6797.CrossRefPubMedPubMedCentral

25.

• Malahias MA, Brilakis E, Avramidis G, Antonogiannakis E. Satisfactory mid-term outcome of subacromial balloon spacer for the treatment of irreparable rotator cuff tears. Knee Surg Sports Traumatol Arthrosc. 2019;27(12):3890–6. https://doi.org/10.1007/s00167-019-05485-4Single center series of 31 patients with mean 22-month follow-up, compared those who had balloon implantation alone to those with balloon implantation and partial repair, found no differences between outcome scores and range of motion between the two groups, with both groups improved from baseline.CrossRefPubMed

26.

•• Holschen M, Brand F, Agneskirchner JD. Subacromial spacer implantation for massive rotator cuff tears: clinical outcome of arthroscopically treated patients. Obere Extrem. 2017;12(1):38–45. https://doi.org/10.1007/s11678-016-0386-9This study is important in that it was a retrospective case-control study of 23 patients comparing arthroscopic debridement and partial repair with balloon spacer and without balloon spacer. They found improvements in both groups, with a higher absolute improvement in the balloon group. While retrospective and not randomized, having a control group makes this study stand out in the current literature on the balloon spacer.CrossRefPubMed

27.

Piekaar RSM, Bouman ICE, van Kampen PM, van EF, Huijsmans PE. Early promising outcome following arthroscopic implantation of the subacromial balloon spacer for treating massive rotator cuff tear. Musculoskelet Surg. 2017. Doi:https://doi.org/10.1007/s12306-017-0525-5.

28.

•• Senekovic V, Poberaj B, Kovacic L, Mikek M, Adar E, Markovitz E, et al. The biodegradable spacer as a novel treatment modality for massive rotator cuff tears: a prospective study with 5-year follow-up. Arch Orthop Trauma Surg. 2017;137(1):95–103. https://doi.org/10.1007/s00402-016-2603-9This prospective study of 24 patients who underwent balloon spacer placement for massive irreparable rotator cuff tear has the longest follow-up of any series, with minimum 5-year follow-up. They reported improvements in functional outcome scores in the majority of patients starting at 3 months and maintained at 5 years with only 10% of patients demonstrating scores that were unchanged or worse than baseline at 5 years.CrossRefPubMed

29.

•• Ruiz-Iban MA, Moreno RL, Diaz RR, Sciamanna RA, Gonzalez AP, Gomez AL, et al. The absorbable subacromial spacer for irreparable posteriosuperior cuff tears has inconsistent results. Knee Surg Sports Traumatol Arthrosc. 2018. https://doi.org/10.1007/s00167-018-5083-3This study of 15 patients undergoing balloon spacer implantation for massive irreparable rotator cuff tear is important because of their poor results at minimum 2-year follow-up. Only 6 patients (40%) had an improvement in Constant score of at least 10 points at 2 years and 5 patients required conversion to reverse shoulder arthroplasty in that time period. These results are important to consider given that they are considerably different than many reports in the literature.

30.

•• Moon AS, Patel HA, Ithurburn MP, Brabston EW, Ponce BA, Momaya AM. Subacromial spacer implantation for the treatment of massive irreparable rotator cuff tears: a systematic review. Arthroscopy. 2019;35(2):607–14. https://doi.org/10.1016/j.arthro.2018.08.006Systematic review on the current literature available regarding outcomes after balloon spacer implantation. The review includes seven studies (six level four, one level three study) and 204 shoulders. All studies reported improvements in Constant score or ASES score at mean 19 months. However, it is important to consider that none of the included studies are level one or two evidence.CrossRefPubMed

31.

Castagna A, Garofalo R, Maman E, Gray AC, Brooks EA. Comparative cost-effectiveness analysis of the subacromial spacer for irreparable and massive rotator cuff tears. Int Orthop. 2019;43(2):395–403. https://doi.org/10.1007/s00264-018-4065-x.CrossRefPubMed

Titel: Subacromial Balloon Spacer Implantation
verfasst von: Melissa A. Wright
Joseph A. Abboud
Anand M. Murthi
Publikationsdatum: 13.07.2020
Verlag: Springer US
Erschienen in: Current Reviews in Musculoskeletal Medicine / Ausgabe 5/2020
Elektronische ISSN: 1935-9748
DOI: https://doi.org/10.1007/s12178-020-09661-9

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Abstract

Purpose of Review

Recent Findings

Summary

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