Acta Scientific Orthopaedics (ISSN: 2581-8635)

Research Article Volume 6 Issue 2

Subacromial Balloon Spacer is an Acceptable Therapeutic Option for Massive and Irreparable Rotator Cuff Tears

Maximiliano Rosenkranz1*, Rafael Poniachik1, Nicolas Castro2, Gonzalo Diaz2, Juan de Dios Errazuriz2, Juan Antonio Castellaro2 and Warner Larrondo2

1Orthopaedic Resident, Clínica Dávila, Universidad de los Andes, Chile
2Shoulder and Elbow Surgeon, Clínica Dávila, Chile

*Corresponding Author: Maximiliano Rosenkranz, Orthopaedic Resident, Clínica Dávila, Universidad de los Andes, Chile.

Received: December 21, 2022; Published: January 11, 2023

Abstract

Introduction: Rotator cuff tear is a frequent pathology, which is present in approximately 50% of patients between 40 and 70 years of age. The concept of irreparability is rather surgical, which is defined according to Rockwood as the inability to carry out a primary repair of the tendon to its original insertion site, so other options must be chosen. Among these, the use of a biodegradable subacromial spacer is a recent technique that has shown good and comparable results with other techniques, with no literature reported in our country to date. The objective of this study is to present the clinical and functional parameters of a series of patients with a diagnosis of massive rupture (≥5 cm or with involvement of 2 or more tendons) and irreparable rotator cuff, treated with a biodegradable subacromial spacer since 2018 at clı́nica Dávila.

Method: The present study corresponds to a cross-sectional study of patients operated with a subacromial spacer from 2018 to 2022 at the Dávila Clinic. A current evaluation was carried out where the QuickDASH and Constant tests were applied.

Results: we obtained 15 of 21 shoulders for evaluation. 66% of patients were men, average age of 59 years and a range from 43 to 70 years at the time of surgery. QuickDASH score for patients evaluated at 6 months post-surgery was 48, 39 at 6 to 12 months post-surgery and 28 in patients evaluated with more than 12 months from surgery. The average Constant score was 52 at patients evaluated at 6 months post-surgery, 51 at 6 to 12 months post-surgery and 78 in patients evaluated with more than 12 months from surgery. Patients were partial repair was performed, higher scores where obtained, bit without statistical analysis made.

Conclusion: Management of massive and irreparable rotator cuff tears remains a challenge, there are multiple treatment options but no consensus about a gold standard for optimal management. The subacromial balloon spacer shows good results in patients with massive and irreparable rotator cuff tears.

Keywords: Subacromial Balloon Spacer; Massive; Irreparable; Rotator Cuff Tears

References

  1. Kovacevic D., et al. “Management of irreparable massive rotator cuff tears: a systematic review and meta-analysis of patient-reported outcomes, reoperation rates, and treatment response”. Journal of Shoulder and Elbow Surgery12 (2020): 2459-2475.
  2. Sher JS., et al. “Abnormal findings on magnetic resonance images of asymptomatic shoulders”. The Journal of Bone and Joint Surgery. American 1 (1995): 10-15.
  3. Teunis T., et al. “A systematic review and pooled analysis of the prevalence of rotator cuff disease with increasing age”. Journal of Shoulder and Elbow Surgery 12 (2014): 1913-1921.
  4. Kucirek NK., et al. “Treatment Options for Massive Irreparable Rotator Cuff Tears”. Current Reviews in Musculoskeletal Medicine5 (2021): 304-315.
  5. Cofield RH. “Subscapular muscle transposition for repair of chronic rotator cuff tears”. Surgery, Gynecology and Obstetrics 5 (1982): 667-672.
  6. Gerber C., et al. “The results of repair of massive tears of the rotator cuff”. The Journal of Bone and Joint Surgery. American 4 (2000): 505-515.
  7. Davidson J and Burkhart SS. “The Geometric Classification of Rotator Cuff Tears: A System Linking Tear Pattern to Treatment and Prognosis”. Journal of Arthroscopic and Related Surgery 3 (2010): 417-24.
  8. Rockwood CA., et al. “Débridement of degenerative, irreparable lesions of the rotator cuff”. The Journal of Bone and Joint Surgery. American 6 (1995): 857-866.
  9. Viswanath A and Drew “Subacromial balloon spacer - Where are we now?” Journal of Clinical Orthopaedics and Trauma 17 (2021): 223-232.
  10. Zhao J., et al. “Risk factors affecting rotator cuff retear after arthroscopic repair: a meta-analysis and systematic review”. Journal of Shoulder and Elbow Surgery 11 (2021): 2660-2670.
  11. Savarese E and Romeo R. “New Solution for Massive, Irreparable Rotator Cuff Tears: The Subacromial “Biodegradable Spacer”. Arthroscopy Techniques 1 (2012): e69-74.
  12. Ramot Y., et al. “Long-term Local and Systemic Safety of Poly (L -lactide-co-epsilon-caprolactone) after Subcutaneous and Intra-articular Implantation in Rats”. Toxicologic Pathology8 (2015): 1127-1140.
  13. Wright , et al. “Subacromial Balloon Spacer Implantation”. Current Reviews in Musculoskeletal Medicine 2013.5 (2020): 584-591.
  14. Singh , et al. “The effect of the subacromial balloon spacer on humeral head translation in the treatment of massive, irreparable rotator cuff tears: a biomechanical assessment”. Journal of Shoulder and Elbow Surgery 28.10 (2019): 1841-1847.
  15. Chevalier Y., et al. “Biodegradable spacer reduces the subacromial pressure: A biomechanical cadaver study”. Clinical Biomechanics 52 (2018): 41-48.
  16. Lobao MH., et al. “Biomechanics of Biodegradable Subacromial Balloon Spacer for Irreparable Superior Rotator Cuff Tears: Study of a Cadaveric Model”. Journal of Bone and Joint Surgery 11 (2019): e49.
  17. Senekovic V., et al. “Prospective clinical study of a novel biodegradable sub-acromial spacer in treatment of massive irreparable rotator cuff tears”. European Journal of Orthopaedic Surgery and Traumatology 3 (2013): 311-316.
  18. Senekovic V., et al. “The biodegradable spacer as a novel treatment modality for massive rotator cuff tears: a prospective study with 5-year follow-up”. Archives of Orthopaedic and Trauma Surgery 1 (2017): 95-103.
  19. Deranlot , et al. “Arthroscopic Subacromial Spacer Implantation in Patients with Massive Irreparable Rotator Cuff Tears: Clinical and Radiographic Results of 39 Retrospectives Cases”. Arthroscopy - Journal of Arthroscopic and Related Surgery 33.9 (2017): 1639-1644.
  20. Familiari F., et al. “Subacromial Balloon Spacer for Massive, Irreparable Rotator Cuff Tears Is Associated with Improved Shoulder Function and High Patient Satisfaction”. Arthroscopy - Journal of Arthroscopic and Related Surgery2 (2021): 480-486.
  21. Piekaar , et al. “The subacromial balloon spacer for massive irreparable rotator cuff tears: approximately 3 years of prospective follow-up”. Musculoskeletal Surgery 104.2 (2020): 207-214.
  22. Oh JH., et al. “Comparing Clinical Outcomes After Subacromial Spacer Insertion Versus Other Reconstruction Methods in the Treatment of Irreparable Massive Rotator Cuff Tears”. Orthopaedic Journal of Sports Medicine 9 (2019): 232596711986960.
  23. Malahias MA., et al. “Arthroscopic partial repair with versus without biodegradable subacromial spacer for patients with massive rotator cuff tears: a case-control study”. Musculoskeletal Surgery 3 (2021): 247-255.
  24. Holschen M., et al. “Subacromial spacer implantation for massive rotator cuff tears: Clinical outcome of arthroscopically treated patients”. Obere Extremitat 1 (2017): 38-45.
  25. Verma N., et al. “InSpace Implant Compared with Partial Repair for the Treatment of Full-Thickness Massive Rotator Cuff Tears: A Multicenter, Single-Blinded, Randomized Controlled Trial”. Journal of Bone and Joint Surgery 14 (2022): 1250-1262.
  26. Metcalfe A., et al. “Subacromial balloon spacer for irreparable rotator cuff tears of the shoulder (START: REACTS): a group-sequential, double- blind, multicentre randomised controlled trial”. The Lancet10339 (2022): 1954-1963.
  27. Stewart RK., et al. “Outcomes of Subacromial Balloon Spacer Implantation for Massive and Irreparable Rotator Cuff Tears: A Systematic Review”. Orthopaedic Journal of Sports Medicine 10 (2019): 232596711987571.
  28. Johns WL., et al. “Implantable Subacromial Balloon Spacers in Patients with Massive Irreparable Rotator Cuff Tears: A Systematic Review of Clinical, Biomechanical, and Financial Implications”. Arthroscopy, Sports Medicine, and Rehabilitation 6 (2020): e855-872.
  29. Health Research04 (2018): 562-569+576.

Citation

Citation: Maximiliano Rosenkranz., et al. “Subacromial Balloon Spacer is an Acceptable Therapeutic Option for Massive and Irreparable Rotator Cuff Tears”.Acta Scientific Orthopaedics 6.2 (2023): 31-35.

Copyright

Copyright: © 2023 Maximiliano Rosenkranz., et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.




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