Erschienen in:
10.08.2018 | Shoulder
The absorbable subacromial spacer for irreparable posterosuperior cuff tears has inconsistent results
verfasst von:
Miguel Angel Ruiz Ibán, Rafael Lorente Moreno, Raquel Ruiz Díaz, Roselyn Álvarez Sciamanna, Andrea Paniagua Gonzalez, Alejandro Lorente Gómez, Jorge Díaz Heredia
Erschienen in:
Knee Surgery, Sports Traumatology, Arthroscopy
|
Ausgabe 12/2018
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Abstract
Purpose
To evaluate the 2-year results of an absorbable subacromial spacer in patients with irreparable posterosuperior rotator cuff tears.
Methods
Prospective longitudinal study of a consecutive case series of 16 subjects with irreparable tears of the posterosuperior rotator cuff in which the InSpace® subacromial spacer was arthroscopically implanted. A full clinical evaluation that included the Constant test, Simple Shoulder Test (SST) and the QuickDash questionnaire was performed preoperatively and at 12 and 24 months follow-up. The primary outcome for assessing the success of the procedure was a variable composed of a clinically relevant variation of the Constant (established in an improvement greater than 10 points) and the absence of surgical reintervention.
Results
Fifteen subjects (11 women/4 men, median age = 69.4 years [interquartile range 7.50], range 60–80 years) completed the 2-year of follow-up. According to the main evaluation criteria, only 6 patients (40%) had a successful outcome. Five subjects required reconversion to a reverse shoulder arthroplasty (at a median of 9.8 months postoperatively) due to absence of clinical improvement or worsening of symptoms. Of the ten remaining subjects, only 6 had improvements greater than 10 points in the Constant score. Despite of this, these 10 subjects had, on average, some improvement in the Constant test (preoperative Constant: median 35.0 [27.0–52.5] vs Constant at 24 months: 53.5 [55.0–84.0], significant differences p = 0.02), in the SST (3.0 [2.0–4.0] vs 6.0 [3.25–7.75], p = 0.039) and in the QuickDASH test (37.0 [33.25–40.0] vs 27.5 [20.5–32.75], p = 0.012).
Conclusions
The outcomes of the implantation of the subacromial biodegradable spacer at 2-year follow-up are not satisfactory. In this small case series only 40% of patients seem to clearly benefit from surgery. One in three required revision to a reverse shoulder arthroplasty. The described technique does not seem a reasonable alternative for the management of the majority of patients with irreparable ruptures of the rotator cuff. The indications of this device should be more clearly defined.