Numerous surgical options are available for the management of massive irreparable rotator cuff tears, but there are no current definitive guidelines concerning the optimal treatment modality. The purpose of this study was to evaluate the efficacy and safety of a biodegradable subacromial spacer (InSpace) implantation in patients with irreparable rotator cuff tears.
Methods
A retrospective study was conducted involving 47 patients treated with the InSpace balloon between 2016 and 2018. Shoulder function was assessed using Constant Score. Pain was scored using a visual analogue scale, with scores ranging from 0 to 10.
Results
At an average follow-up of 24.6 months (range 12–38), the Constant Score had improved from 39.4 to 71.5 points (p < 0.0001). The range of motion, a main component of Constant Score, was improved after two years, from 27.6 to 42.2 points (p < .001). The visual analogue scale score decreased from 6.32 at baseline to a mean score of 2.7 points (p < 0.0001).
Discussion
Arthroscopic deployment of the InSpace device was found to be a safe, reliable treatment option in patients with painful irreparable rotator cuff tears, with meaningful improvement in shoulder function without serious complications.
BediADinesJWarrenRF, et al.Massive tears of the rotator cuff. J Bone Joint Surg Am2010; 92: 1894–1908.
2.
RockwoodCAWilliamsGRBurkheadWZ. Debridement of degenerative, irreparable lesions of the rotator cuff. J Bone Joint Surg Am1995; 77: 857–866.
3.
CofieldRHParviziJHoffmeyerPJ, et al.Surgical repair of chronic rotator cuff tears. A prospective long-term study. J Bone Joint Surg Am2001; 83: 71–77.
4.
GerberCFuchsBHodlerJ. The results of repair of massive tears of the rotator cuff. J Bone Joint Surg Am2000; 82: 505–515.
5.
ThomazeauHRollandYLucasC, et al.Atrophy of the supraspinatus belly. Assessment by MRI in 55 patients with rotator cuff pathology. Acta Orthop Scand1996; 67: 264–268.
6.
GoutallierDPostelJMBernageauJ, et al.Fatty muscle degeneration in cuff ruptures. Pre- and post-operative evaluation by CT scan. Clin Orthop Relat Res1994; 304: 78–83.
7.
FehringerEVSunJVanOeverenLS, et al.Full-thickness rotator cuff tear prevalence and correlation with function and co-morbidities in patients sixty-five years and older. J Shoulder Elbow Surg2008; 17: 881–885.
8.
YamamotoATakagishiKOsawaT, et al.Prevalence and risk factors of a rotator cuff tear in the general population. J Shoulder Elbow Surg2010; 19: 116–120.
BerthANeumannWAwiszusF, et al.Massive rotator cuff tears: functional outcome after debridement or arthroscopic partial repair. J Orthop Traumatol2010; 11: 13–20.
11.
OmidRLeeB. Tendon transfers for irreparable rotator cuff tears. J Am Acad Orthop Surg2013; 21: 492–501.
12.
SavareseERomeoR. New solution for massive, irreparable rotator cuff tears: the subacromial “biodegradable spacer”. Arthrosc Tech2012; 1: e69–e74.
13.
KukkonenJKaukoTVahlbergT, et al.Investigating minimal clinically important difference for Constant score in patients undergoing rotator cuff surgery. J Shoulder Elbow Surg2013; 22: 1650–1655.
14.
SenekovicVPoberajBKovacicL, 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 Surg2017; 137: 95–103.
15.
PiekaarRSMBoumanICEvan KampenPM, et al.Early promising outcome following arthroscopic implantation of the subacromial balloon spacer for treating massive rotator cuff tear. Musculoskelet Surg2018; 102: 247–255.
16.
DeranlotJHerissonONourissatG, et al.Arthroscopic subacromial spacer implantation in patients with massive irreparable rotator cuff tears: clinical and radiographic results of 39 retrospectives cases. Arthroscopy2017; 33: 1639–1644.
17.
RicciMVecchiniEBonfanteE, et al.A clinical and radiological study of biodegradable subacromial spacer in the treatment of massive irreparable rotator cuff tears. Acta Biomed2017; 88: 75–80.
18.
NaggarL. Massive irreparable rotator cuff tears without arthropathy: the role of the balloon (biodegradable spacer) and comparison with other operative treatments. Orthop Proc2016; 98-B: 13–13.
19.
Ruiz IbánMALorente MorenoRRuiz DíazR, et al.The absorbable subacromial spacer for irreparable posterosuperior cuff tears has inconsistent results. Knee Surg Sports Traumatol Arthrosc2018; 26: 3848–3854.
20.
PratDTenenbaumSPritschM, et al.Sub-acromial balloon spacer for irreparable rotator cuff tears: is it an appropriate salvage procedure?J Orthop Surg2018; 26: 1–7.
21.
Singh S. A biomechanical study examining the subacromial balloon spacer and superior capsular reconstruction in the treatment of massive, irreparable rotator cuff tears. Master’s Thesis, University of Western Ontario, Canada, 2017.
22.
HolschenMBrandFAgneskirchnerJD. Subacromial spacer implantation for massive rotator cuff tears: clinical outcome of arthroscopically treated patients. Obere Extrem2017; 12: 38–45.
23.
LiemDLengersNDedyN, et al.Arthroscopic debridement of massive irreparable rotator cuff tears. Arthroscopy2008; 24: 743–748.
24.
LeeBChoNRheeY. Results of arthroscopic decompression and tuberoplasty for irreparable massive rotator cuff tears. Arthroscopy2011; 27: 1341–1350.
25.
BoileauPBaqueFValerioL, et al.Isolated arthroscopic biceps tenotomy or tenodesis improves symptoms in patients with massive irreparable rotator cuff tears. J Bone Joint Surg Am2007; 89: 747–757.
26.
KempfJFGleyzePBonnometF, et al.A multicentre study of 210 rotator cuff tears treated by arthroscopic acromioplasty. Arthroscopy1999; 15: 56–66.
27.
BuchmannSPlathJEImhoffAB. [Latissimus dorsi transfer for the treatment of irreparable rotator tears: indication, surgical technique, and modifications]. Oper Orthop Traumatol2012; 24: 502–512 (in German).
28.
HabermeyerPMagoschPRudolphT, et al.Transfer of the tendon of latissimus dorsi for the treatment of massive tears of the rotator cuff: a new single-incision technique. J Bone Joint Surg Br2006; 88: 208–212.
29.
ElhassanBTWagnerERWerthelJD. Outcome of lower trapezius transfer to reconstruct massive irreparable posterior-superior rotator cuff tear. J Shoulder Elbow Surg2016; 25: 1346–1353.
30.
Nové-JosserandLCostaPLiotardJP, et al.Results of latissimus dorsi tendon transfer for irreparable cuff tears. Orthop Traumatol Surg Res2009; 95: 108–113.
31.
El-AzabHMRottOIrlenbuschU. Long-term follow-up after latissimus dorsi transfer for irreparable posterosuperior rotator cuff tears. J Bone Joint Surg2015; 97: 462–469.
32.
TauroJC. Arthroscopic “interval slide” in the repair of large rotator cuff tears. Arthroscopy1999; 15: 527–530.
33.
KimSJKimSHLeeSK, et al.Arthroscopic repair of massive contracted rotator cuff tears: aggressive release with anterior and posterior interval slides do not improve cuff healing and integrity. J Bone Joint Surg Am2013; 95: 1482–1488.
34.
MihataTLeeTQWatanabeC, et al.Clinical results of arthroscopic superior capsule reconstruction for irreparable rotator cuff tears. Arthroscopy2013; 29: 459–470.
35.
CastagnaAGarofaloRMamanE, et al.Comparative cost-effectiveness analysis of the subacromial spacer for irreparable and massive rotator cuff tears. Int Orthop2019; 43: 395–403.
