The treatment of irreparable massive rotator cuff tears with inspace balloon: rational and medium-term results
Keywords:
Massive irreparable rotator cuff tears, Inspace balloon, shoulder arthroscopyAbstract
Background and aim: The treatment of irreparable massive rotator cuff tears (MIRCTs) represents a challenge for the orthopedic surgeon both for the affected population and for the intrinsic characteristics of the injury. There are different types of treatment ranging from bursectomy to reverse shoulder prosthesis and subacromial spacers.
The aim of the work is to establish the clinical and functional improvement of patients treated with subacromial spacer.
Methods: we conducted 2 studies: the first analyzing a sample of 24 patients (14 females and 10 male, mean age 65.7 years) operated between 2015 and 2017 whose last follow up dates back to October 2021 and a second one analyzing 55 patients (including patients of the first sample) (30 females and 25 males, mean age 64 years) over a period of time from 2015 to 2021. The mean follow up was 56 months.
All patients were diagnosed with irreparable massive rotator cuff tears and treated with subacromial spacer.
Results: the result in both studies was an increase of Constant score, tripled from the pre-operative values, in ROM, doubled, and a reduction of VAS.
Conclusions: the clinical results are encouraging and the use of the subacromial spacer could be a valid surgical alternative for patients with MIRCTs. However, we needed randomized trials with long-term follow-up.
References
Yamamoto A, Takagishi K, Osawa T, Yanagawa T, Nakajima D, Shitara H, et al. Prevalence and risk factors of a rotator cuff tear in the general population. J Shoulder Elbow Surg. 2010 Jan;19(1):116–20.
Chakravarty K, Webley M. Shoulder joint movement and its relationship to disability in the elderly. J Rheumatol. 1993 Aug;20(8):1359–61.
Gerber C, Wirth SH, Farshad M. Treatment options for massive rotator cuff tears. J Shoulder Elbow Surg. 2011 Mar;20(2 Suppl):S20–9.
Bedi A, Dines J, Warren RF, Dines DM. Massive tears of the rotator cuff. J Bone Joint Surg Am. 2010 Aug 4;92(9):1894–908.
Kissenberth MJ, Rulewicz GJ, Hamilton SC, Bruch HE, Hawkins RJ. A positive tangent sign predicts the repairability of rotator cuff tears. J Shoulder Elbow Surg. 2014 Jul;23(7):1023–7.
Meyer DC, Farshad M, Amacker NA, Gerber C, Wieser K. Quantitative analysis of muscle and tendon retraction in chronic rotator cuff tears. Am J Sports Med. 2012 Mar;40(3):606–10.
Kovacevic D, Suriani RJ Jr, Grawe BM, Yian EH, Gilotra MN, Hasan SA, et al. Management of irreparable massive rotator cuff tears: a systematic review and meta-analysis of patient-reported outcomes, reoperation rates, and treatment response. J Shoulder Elbow Surg. 2020 Dec;29(12):2459–75.
Yao J, Dines DM, Warren RF. Surgical Arthroplasty Options for Rotator Cuff Tear Arthropathy [Internet]. Vol. 4, Techniques in Shoulder and Elbow Surgery. 2003. p. 26–34. Available from: http://dx.doi.org/10.1097/00132589-200303000-00004
Boileau P, Baqué F, Valerio L, Ahrens P, Chuinard C, Trojani C. Isolated Arthroscopic Biceps Tenotomy or Tenodesis Improves Symptoms in Patients with Massive Irreparable Rotator Cuff Tears [Internet]. Vol. 89, The Journal of Bone and Joint Surgery-American Volume. 2007. p. 747–57. Available from: http://dx.doi.org/10.2106/00004623-200704000-00008
Savarese E, Romeo R. New solution for massive, irreparable rotator cuff tears: the subacromial “biodegradable spacer.” Arthrosc Tech. 2012 Sep;1(1):e69–74.
Stanwood W, Marra G. Massive rotator cuff tears [Internet]. Vol. 12, Current Opinion in Orthopedics. 2001. p. 319–24. Available from: http://dx.doi.org/10.1097/00001433-200108000-00010
Walch G, Bradley Edwards T, Boulahia A, Nové-Josserand L, Neyton L, Szabo I. Arthroscopic tenotomy of the long head of the biceps in the treatment of rotator cuff tears: Clinical and radiographic results of 307 cases [Internet]. Vol. 14, Journal of Shoulder and Elbow Surgery. 2005. p. 238–46. Available from: http://dx.doi.org/10.1016/j.jse.2004.07.008
Abtahi AM, Granger EK, Tashjian RZ. Factors affecting healing after arthroscopic rotator cuff repair. World J Orthop. 2015 Mar 18;6(2):211–20.
Gürsoy S. Efficacy of Corticosteroid Injection in the Conservative Treatment of Subacromial Impingement Syndrome [Internet]. Ankara Medical Journal. 2018. Available from: http://dx.doi.org/10.17098/amj.501834
Kesmezacar H, Babacan M, Erginer R, Oğüt T, Cansü E. [The value of acromioplasty in the treatment of subacromial impingement syndrome]. Acta Orthop Traumatol Turc. 2003;37 Suppl 1:35–41.
Frankle MA, Kumar AG. Reverse Total Shoulder Replacement for Arthritis With an Irreparable Rotator Cuff Tear [Internet]. Vol. 4, Techniques in Shoulder and Elbow Surgery. 2003. p. 77–83. Available from: http://dx.doi.org/10.1097/00132589-200306000-00006
Hazel A, Lee TQ, Gupta R. Reverse total shoulder arthroplasty [Internet]. Vol. 20, Current Orthopaedic Practice. 2009. p. 355–64. Available from: http://dx.doi.org/10.1097/bco.0b013e3181a93b69
Wierks C, Skolasky RL, Ji JH, McFarland EG. Reverse total shoulder replacement: intraoperative and early postoperative complications. Clin Orthop Relat Res. 2009 Jan;467(1):225–34.
Burkhart SS, Esch JC, Scott Jolson R. The Rotator Crescent and Rotator Cable: An Anatomic Description of the Shoulder’s “Suspension Bridge” [Internet]. Vol. 26, Arthroscopy: The Journal of Arthroscopic & Related Surgery. 2010. p. 256–7. Available from: http://dx.doi.org/10.1016/j.arthro.2009.11.012
Tauro JC. Arthroscopic “interval slide” in the repair of large rotator cuff tears. Arthroscopy. 1999 Jul;15(5):527–30.
Mihata T, McGarry MH, Pirolo JM, Kinoshita M, Lee TQ. Superior capsule reconstruction to restore superior stability in irreparable rotator cuff tears: a biomechanical cadaveric study. Am J Sports Med. 2012 Oct;40(10):2248–55.
Senekovic V, Poberaj B, Kovacic L, Mikek M, Adar E, Dekel A. Prospective clinical study of a novel biodegradable sub-acromial spacer in treatment of massive irreparable rotator cuff tears. Eur J Orthop Surg Traumatol. 2013 Apr;23(3):311–6.
Wall B, Nové-Josserand L, O’Connor DP, Edwards TB, Walch G. Reverse total shoulder arthroplasty: a review of results according to etiology. J Bone Joint Surg Am. 2007 Jul;89(7):1476–85.
Gerber C, Maquieira G, Espinosa N. Latissimus dorsi transfer for the treatment of irreparable rotator cuff tears. J Bone Joint Surg Am. 2006 Jan;88(1):113–20.
Castro WHM, Jerosch J. Examination and Diagnosis of Musculoskeletal Disorders: History - Physical Examination - Imaging Techniques - Arthroscopy. Thieme; 2011. 164 p.
Ellman H, Hanker G, Bayer M. Repair of the rotator cuff. End-result study of factors influencing reconstruction. J Bone Joint Surg Am. 1986 Oct;68(8):1136–44.
Reeves JM, Singh S, Langohr GDG, Athwal GS, Johnson JA. An in-vitro biomechanical assessment of humeral head migration following irreparable rotator cuff tear and subacromial balloon reconstruction [Internet]. Vol. 12, Shoulder & Elbow. 2020. p. 265–71. Available from: http://dx.doi.org/10.1177/1758573219865479
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 Jun 5;101(11):e49.
Familiari F, Nayar SK, Russo R, De Gori M, Ranuccio F, Mastroianni V, et al. Subacromial Balloon Spacer for Massive, Irreparable Rotator Cuff Tears Is Associated With Improved Shoulder Function and High Patient Satisfaction. Arthroscopy. 2021 Feb;37(2):480–6.
Prat D, Tenenbaum S, Pritsch M, Oran A, Vogel G. Sub-acromial balloon spacer for irreparable rotator cuff tears: Is it an appropriate salvage procedure? [Internet]. Vol. 26, Journal of Orthopaedic Surgery. 2018. p. 230949901877088. Available from: http://dx.doi.org/10.1177/2309499018770887
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Copyright (c) 2021 Eugenio Vecchini, Marco Gulmini, Angelo Peluso, Giacomo Fasoli, Angela Anselmi, Tommaso Maluta, Damiano De Cristan, Bruno Magnan, Matteo Ricci
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