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Sirignano M, Nyland J, Krupp R. Subacromial balloon spacer massive rotator cuff tear treatment systematic review and meta-analysis: Patient selection and physical therapy may be keys to outcome success. Knee Surg Sports Traumatol Arthrosc 2024; 32:2346-2357. [PMID: 38922784 DOI: 10.1002/ksa.12331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Revised: 06/10/2024] [Accepted: 06/11/2024] [Indexed: 06/28/2024]
Abstract
PURPOSE Subacromial balloon spacer implantation (SBSI) efficacy for massive rotator cuff tear treatment was evaluated based on perceived shoulder function, active shoulder mobility, pain, complications and research study methodological quality. The purpose was to better discern the efficacy of this device from both surgical and rehabilitative perspectives to improve patient outcomes. METHODS PubMed, EMBASE and Cochrane Library databases were searched (1 January 2010 to 1 June 2024) using 'balloon spacer', 'subacromial spacer', 'subacromial balloon spacer', 'shoulder spacer' and 'inspace' terms. Pre-surgery (baseline), 12-month (12-m) and 24-month (24-m) post-SBSI mean changes were compared using one-way ANOVA and Scheffe post hoc tests, and comparative study effect sizes were calculated (p ≤ 0.05). RESULTS This review consists of 27 studies with 894 patients (67.8 ± 5 years of age) and 29.4 ± 17-month follow-up. Modified Coleman Methodology Scores (MCMS) revealed fair overall quality (mean = 61.4 ± 11). Constant-Murley scores improved from 34.8 ± 6 (baseline), to 64.2 ± 9 (12-m) and 67.9 ± 8 (24-m) (12-m, 24-m > baseline, p < 0.001). ASES scores improved from 35.1 ± 14 (baseline), to 83.3 ± 7 (12-m) and 81.8 ± 5 (24-m)(12-m, 24-m > baseline, p < 0.001). VAS pain scores improved from 6.6 ± 1 (baseline), to 2.6 ± 1 (12-m) and 2.0 ± 1 (24-m) (12-m, 24-m < baseline, p < 0.001). Flexion increased from 108.5 ± 25° (baseline), to 128.5 ± 30° (12-m) and 151.2 ± 14° (24-m) (24-m > 12-m, baseline, p = 0.01). Abduction increased from 97.7 ± 24° (baseline) to 116.3 ± 23° (12-m) and 142.3 ± 15° (24-m) (24-m > 12-m, baseline, p = 0.02). External rotation (ER) in adduction changed from 33.1 ± 7° (baseline) to 32.5 ± 4° (12-m) and 53.9 ± 9° (24-m)(24-m > 12-m, baseline, p = 0.01). ER at 90° abduction increased from 56.3 ± 3° (baseline) to 83.5 ± 5° (12-m) and 77.1 ± 4° (24-m) (24-m, 12-m > baseline, p = 0.01). Comparison studies, however, displayed insignificant results with small effect sizes. CONCLUSION Despite overall fair MCMS scores, at 24-m post-SBSI, shoulder function improved and pain decreased. More rigorous comparative studies, however, revealed insignificant findings. Patients with the potential to re-establish the essential glenohumeral joint force couple that depresses the humeral head on the glenoid fossa and who comply with physical therapy may be more likely to achieve success following SBSI. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Michael Sirignano
- Department of Orthopaedic Surgery, University of Louisville, Louisville, Kentucky, USA
| | - John Nyland
- Department of Orthopaedic Surgery, University of Louisville, Louisville, Kentucky, USA
- Norton Orthopaedic Institute, Louisville, Kentucky, USA
| | - Ryan Krupp
- Department of Orthopaedic Surgery, University of Louisville, Louisville, Kentucky, USA
- Norton Orthopaedic Institute, Louisville, Kentucky, USA
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Malige A, Tibone JE, Hui A, Kwak D, Jewell J, McGarry MH, Lee TQ. A Biological Spacer to Treat Irreparable Rotator Cuff Tears: A Biomechanical Study Utilizing a Secured Versus Unsecured Tensor Fascia Lata Graft. Am J Sports Med 2024; 52:2092-2100. [PMID: 38822576 DOI: 10.1177/03635465241252140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/03/2024]
Abstract
BACKGROUND Designed to help treat pain and loss of function after rotator cuff repair, allograft spacer procedures utilize a graft to act as a spacer in the subacromial space, decreasing pain from impingement of the greater tuberosity on the acromion at the extremes of overhead motion. PURPOSE To evaluate the biomechanical characteristics of secured versus unsecured tensor fascia lata allografts used in an allograft spacer procedure. STUDY DESIGN Controlled laboratory study. METHODS A total of 8 fresh-frozen cadaveric shoulder specimens were used. There were 4 conditions tested: (1) intact rotator cuff, (2) stage III rotator cuff tear (complete supraspinatus tendon and superior one-half of the infraspinatus tendon), (3) unsecured tensor fascia lata graft, and (4) secured tensor fascia lata graft. Both superior and posterior translation of the humeral head were calculated in each condition. A 4-cm × 5-cm × 6-mm tensor fascia lata graft was used in the subacromial space to act as a spacer. Grafts were secured at the lateral edge of the native rotator cuff footprint with 2 knotless anchors. RESULTS With unbalanced loading, both secured and unsecured grafts varied in their ability to limit superior and posterior translation at various rotation angles back to levels seen with intact rotator cuffs at 0° and 20° of abduction. During balanced loading, both unsecured and secured grafts limited superior and posterior translation more than those seen in the rotator cuff-deficient condition (P < .01) and similar to those seen in the intact condition (P > .05). The secured and unsecured grafts allowed similar amounts of translation at every position with both unbalanced and balanced loading (P > .05). Finally, total graft motion was <7 mm in all positions. CONCLUSION Unsecured tensor fascia lata grafts were biomechanically equivalent to secured grafts when used during allograft spacer procedures. CLINICAL RELEVANCE While both grafts were successful at limiting superior and posterior translation of the humeral head during early range of motion, the unsecured graft represents a cheaper, easier option to utilize during allograft spacer procedures.
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Affiliation(s)
- Ajith Malige
- Cedars-Sinai Kerlan-Jobe Institute, Los Angeles, California, USA
| | - James E Tibone
- Cedars-Sinai Kerlan-Jobe Institute, Los Angeles, California, USA
| | - Aaron Hui
- Congress Medical Foundation, Pasadena, California, USA
| | - Daniel Kwak
- Congress Medical Foundation, Pasadena, California, USA
| | - Josh Jewell
- Congress Medical Foundation, Pasadena, California, USA
| | | | - Thay Q Lee
- Congress Medical Foundation, Pasadena, California, USA
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Sandler AB, Gil LG, Scanaliato JP, Green CK, Dunn JC, Parnes N. Subacromial Balloon Placement Demonstrates No Advantage Over Debridement in the Treatment of Massive Irreparable Rotator Cuff Tears: A Dual-Armed Systematic Review and Meta-analysis of Over 1000 Patients. Am J Sports Med 2024; 52:1088-1097. [PMID: 37369101 DOI: 10.1177/03635465231168127] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/29/2023]
Abstract
BACKGROUND In recent years, the placement of a subacromial balloon (SAB) spacer has emerged as a treatment option for massive irreparable rotator cuff tears (MIRCTs); however, there is significant controversy regarding its utility in comparison with other surgical interventions. PURPOSE To compare outcomes after SAB spacer placement versus arthroscopic debridement for MIRCTs. STUDY DESIGN Dual-armed systematic review and meta-analysis (level IV evidence). METHODS A literature search of PubMed (MEDLINE), Scopus, and CINAHL Complete databases for articles published before May 7, 2022, was conducted to identify patients with MIRCTs undergoing the 2 procedures. For the SAB arm, 14 of 449 studies were considered eligible for inclusion, while 14 of 272 studies were considered eligible for inclusion in the debridement arm. RESULTS In total, 528 patients were eligible for inclusion in the SAB arm and 479 patients in the debridement arm, and 69.9% of patients undergoing SAB placement also underwent concomitant debridement. Decreases in the visual analog scale (VAS) pain score and increases in the Constant score were found to be significantly larger after debridement (-0.7 points [P < .001] and +5.5 points [P < .001], respectively), although the Patient Acceptable Symptom State for the VAS was not achieved after either procedure. Both SAB placement and debridement significantly improved range of motion in forward flexion/forward elevation, internal and external rotation, and abduction (P < .001). Rates of general complication were higher after debridement versus SAB placement (5.2% ± 5.6% vs 3.5% ± 6.3%, respectively; P < .001); however, there were no significant differences between SAB placement and debridement in rates of persistent symptoms requiring a reintervention (3.3% ± 6.2% vs 3.8% ± 7.3%, respectively; P = .252) or reoperation rates (5.1% ± 7.6% vs 4.8% ± 8.4%, respectively; P = .552). The mean time to conversion to reverse total shoulder arthroplasty was 11.0 versus 25.4 months, respectively, for the SAB versus debridement arm. CONCLUSION While SAB placement was associated with acceptable postoperative outcomes in the treatment of MIRCTs, there was no clear benefit over debridement alone. Shorter operative times coupled with better postoperative outcomes and longer times to conversion to reverse total shoulder arthroplasty rendered debridement a more attractive option. While there may be a role for SAB placement in poor surgical candidates, there is burgeoning evidence to support debridement alone without SAB placement for the treatment of MIRCTs.
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Affiliation(s)
- Alexis B Sandler
- William Beaumont Army Medical Center/Texas Tech University Health Sciences Center, El Paso, Texas, USA
- Texas Tech University Health Sciences Center, El Paso, Texas, USA
| | - Luis G Gil
- Robbins College of Health and Human Sciences, Baylor University, Waco, Texas, USA
| | - John P Scanaliato
- William Beaumont Army Medical Center/Texas Tech University Health Sciences Center, El Paso, Texas, USA
- Texas Tech University Health Sciences Center, El Paso, Texas, USA
| | - Clare K Green
- School of Medicine and Health Sciences, George Washington University, Washington, District of Columbia, USA
| | - John C Dunn
- William Beaumont Army Medical Center/Texas Tech University Health Sciences Center, El Paso, Texas, USA
- Texas Tech University Health Sciences Center, El Paso, Texas, USA
| | - Nata Parnes
- Department of Orthopedics, Carthage Area Hospital, Carthage, New York, USA
- Department of Orthopedics, Claxton-Hepburn Medical Center, Ogdensburg, New York, USA
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Levy KH, White CA, Pujari A, Patel AV, Kator JL, Parsons BO, Galatz LM, Cagle PJ. Subacromial Balloon Spacer Implantation Is a Promising Alternative for Patients With Massive Irreparable Rotator Cuff Tears: A Systematic Review. Arthroscopy 2024; 40:162-173.e2. [PMID: 37355186 DOI: 10.1016/j.arthro.2023.05.028] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 05/20/2023] [Accepted: 05/29/2023] [Indexed: 06/26/2023]
Abstract
PURPOSE To provide an overview of the existing literature on subacromial balloon spacers for the treatment of massive irreparable rotator cuff tears, in an effort to inform surgeons of the procedure's clinical effectiveness. METHODS The PubMed, Scopus, and Ovid EMBASE databases were queried to identify studies evaluating the clinical, radiographic, and patient-reported outcomes of patients indicated for subacromial balloon spacer implantation. The following datapoints were extracted: study demographics, patient baseline characteristics, and postoperative outcomes of interest. Outcomes were evaluated at baseline and at the longest available follow-up period. RESULTS A total 766 patients were included among 22 included studies, with an average follow-up of 27.54 months. Improvements were seen for all clinical and patient-reported outcomes: forward elevation (ranging from 9.20 to 90.00° improvement), external rotation (ranging from 2.00 to 22.00°), abduction (ranging from 14.00 to 95.00°), Total Constant Score (ranging from 7.70 to 50.00), American Shoulder and Elbow Surgeons score (ranging from 24.60 to 59.84), Oxford Shoulder Score (ranging from 7.20 to 22.20), and pain score (ranging from 3.57 to 6.50). Minimal differences were seen in acromiohumeral interval (ranging from -2.00 to 1.27). Reoperation and complication rates ranged from 0% to 33% and 0% to 19.64%, respectively. CONCLUSIONS The short-term results of subacromial balloon spacers for management of massive rotator cuff tears demonstrate clinically relevant improvements in shoulder range of motion and substantial improvements in patient-reported outcome measures. Of note, minimal change in acromiohumeral interval was seen on postoperative radiography, and wide variations in complication and reoperation rates were reported across studies. LEVEL OF EVIDENCE Level IV, systematic review of Level I-IV studies.
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Affiliation(s)
- Kenneth H Levy
- Department of Orthopedic Surgery, Icahn School of Medicine at Mount Sinai, New York City, New York, U.S.A
| | - Christopher A White
- Department of Orthopedic Surgery, Icahn School of Medicine at Mount Sinai, New York City, New York, U.S.A
| | - Amit Pujari
- Department of Orthopedic Surgery, Icahn School of Medicine at Mount Sinai, New York City, New York, U.S.A
| | - Akshar V Patel
- Department of Orthopedic Surgery, Icahn School of Medicine at Mount Sinai, New York City, New York, U.S.A
| | - Jamie L Kator
- Department of Orthopedic Surgery, Icahn School of Medicine at Mount Sinai, New York City, New York, U.S.A
| | - Bradford O Parsons
- Department of Orthopedic Surgery, Icahn School of Medicine at Mount Sinai, New York City, New York, U.S.A
| | - Leesa M Galatz
- Department of Orthopedic Surgery, Icahn School of Medicine at Mount Sinai, New York City, New York, U.S.A
| | - Paul J Cagle
- Department of Orthopedic Surgery, Icahn School of Medicine at Mount Sinai, New York City, New York, U.S.A..
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Berk AN, Cregar WM, Gachigi KK, Trofa DP, Schiffern SC, Hamid N, Rao AJ, Saltzman BM. Outcomes of subacromial balloon spacer implantation for irreparable rotator cuff tears: a systematic review and meta-analysis. J Shoulder Elbow Surg 2023; 32:2180-2191. [PMID: 37247776 DOI: 10.1016/j.jse.2023.04.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 04/02/2023] [Accepted: 04/12/2023] [Indexed: 05/31/2023]
Abstract
BACKGROUND The management of irreparable rotator cuff tears remains a topic of considerable debate among orthopedic surgeons. Currently, there is little consensus regarding the gold-standard treatment; however, an emerging option involves the use of a biodegradable subacromial spacer. The purpose of this study, therefore, was to systematically review and synthesize the current literature reporting on the clinical outcomes following implantation of a subacromial balloon spacer (SABS) for the treatment of patients with irreparable rotator cuff tears. METHODS A systematic review of the PubMed Central, MEDLINE, Embase, Scopus, and Cochrane Library databases from inception through December 2022 was performed. Clinical outcome studies reporting on functional and clinical outcomes, as well as postoperative complications, were included. RESULTS A total of 127 studies were initially identified, of which 28 were deemed eligible for inclusion in our review. Of these studies, 17 reported adequate preoperative and postoperative data (mean and a measure of variance) and thus were included in the meta-analysis. Among the included studies, a total of 894 shoulders (886 patients) were included; the mean age was 67.4 years (range, 61.7-76.2 years). The average follow-up period was 30.4 months (range, 12-56 months). All postoperative patient-reported outcomes improved significantly from baseline, including the Constant score (mean difference, 33.53; P < .001), American Shoulder and Elbow Surgeons score (mean difference, 40.38; P < .001), Oxford Shoulder Score (mean difference, 12.05; P = .004), and visual analog scale pain score or Numeric Pain Rating Scale score (mean difference, -3.79; P < .001). Forward elevation (mean difference, 24°; P < .001), abduction (mean difference, 52°; P = .02), and external rotation (mean difference, 15°; P < .001) improved. Device-related complications occurred at a rate of 3.6%, the most common of which were balloon migration (1.0%) and synovitis (0.6%). Ultimately, 5% of patients required salvage reverse shoulder arthroplasty. CONCLUSION Short-term outcomes suggest that SABS implantation can be a safe and effective treatment and appears to be associated with early improvements in postoperative pain and function. Clinical heterogeneity, use of concomitant procedures, and variations in patient selection limit our ability to conclusively interpret the available evidence. We do not yet know the potential therapeutic value of SABS implantation relative to other currently accepted treatment strategies, the length of symptomatic improvement that can be expected, or the long-term implications of SABS use on the outcomes of further salvage procedures.
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Affiliation(s)
- Alexander N Berk
- OrthoCarolina Sports Medicine Center, Charlotte, NC, USA; OrthoCarolina Research Institute, Charlotte, NC, USA; Atrium Health Musculoskeletal Institute, Charlotte, NC, USA
| | - William M Cregar
- OrthoCarolina Sports Medicine Center, Charlotte, NC, USA; OrthoCarolina Research Institute, Charlotte, NC, USA; Atrium Health Musculoskeletal Institute, Charlotte, NC, USA
| | | | - David P Trofa
- Department of Orthopaedics, NewYork-Presbyterian/Columbia University Irving Medical Center, New York, NY, USA
| | - Shadley C Schiffern
- OrthoCarolina Sports Medicine Center, Charlotte, NC, USA; OrthoCarolina Research Institute, Charlotte, NC, USA; Atrium Health Musculoskeletal Institute, Charlotte, NC, USA
| | - Nady Hamid
- OrthoCarolina Sports Medicine Center, Charlotte, NC, USA; OrthoCarolina Research Institute, Charlotte, NC, USA; Atrium Health Musculoskeletal Institute, Charlotte, NC, USA
| | - Allison J Rao
- Department of Orthopedic Surgery, University of Minnesota Physicians, University of Minnesota, Minneapolis, MN, USA
| | - Bryan M Saltzman
- OrthoCarolina Sports Medicine Center, Charlotte, NC, USA; OrthoCarolina Research Institute, Charlotte, NC, USA; Atrium Health Musculoskeletal Institute, Charlotte, NC, USA.
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Fury MS, Cirino CM, White AE, Bauer TW, Taylor SA. Rice-Body Synovitis, Foreign Body Reaction, and Rotator Cuff Failure After Subacromial Balloon Spacer Augmentation of a Rotator Cuff Repair: A Case Report. JBJS Case Connect 2023; 13:01709767-202306000-00040. [PMID: 37235697 DOI: 10.2106/jbjs.cc.23.00009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
CASE A 66-year-old woman presented with shoulder pain and weakness 4 months after augmentation of a rotator cuff repair with a Stryker InSpace subacromial balloon spacer. A magnetic resonance imaging (MRI) demonstrated a failed rotator cuff repair, large effusion with rice bodies, synovitis, axillary lymphadenopathy, loose anchors, and erosive changes to the greater tuberosity. Arthroscopy revealed balloon fragmentation surrounded by diffusely hyperemic synovium without repairable cuff tissue. Final cultures proved negative for infection. Histologic evaluation revealed ulcerated synovium with diffuse chronic and focal acute inflammation. CONCLUSION Despite promising early results, augmentation of a rotator cuff repair with a subacromial balloon spacer introduces a risk of inflammatory reaction that may mimic a deep infection and compromise rotator cuff healing.
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Affiliation(s)
- Matthew S Fury
- Department of Sports Medicine and Shoulder Surgery, Hospital for Special Surgery, New York, New York
| | - Carl M Cirino
- Department of Sports Medicine and Shoulder Surgery, Hospital for Special Surgery, New York, New York
| | - Alex E White
- Department of Sports Medicine and Shoulder Surgery, Hospital for Special Surgery, New York, New York
| | - Thomas W Bauer
- Department of Pathology and Laboratory Medicine, Hospital for Special Surgery, New York, New York
| | - Samuel A Taylor
- Department of Sports Medicine and Shoulder Surgery, Hospital for Special Surgery, New York, New York
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Poor Results After Arthroscopic Treatment of Irreparable Rotator Cuff Tears Using a Subacromial Balloon Spacer. J Am Acad Orthop Surg 2022; 30:e1260-e1268. [PMID: 35834816 DOI: 10.5435/jaaos-d-22-00025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Accepted: 04/18/2022] [Indexed: 02/01/2023] Open
Abstract
INTRODUCTION Arthroscopic balloon spacer arthroplasty (BSA) is a relatively recent procedure for patients with irreparable rotator cuff tears, conceived to prevent degenerative joint changes and relieve subacromial pain. METHODS This is a retrospective case series of 16 consecutive patients treated with BSA and followed up for a minimum 12 months. Besides BSA, partial tendon repair was done whenever possible. Radiographical parameters such as acromiohumeral distance and Hamada stage were measured preoperatively and postoperatively. Range of motion, functional results (Constant score; Simple Shoulder Test; American Shoulder and Elbow Surgeons score; and Disabilities of the Arm, Shoulder, and Hand score), health-related quality of life results with the EuroQol Five Dimensions tool, complications, and patient satisfaction were also analyzed. RESULTS The mean age was 64 ± 10.3 years, and the male/female ratio was 6/10. Partial repair was achieved in five patients (31.2%) and did not influence functional or health-related quality of life results ( P = 0.11). The mean acromiohumeral distance and Hamada stage worsened from preoperative measures (3.7 ± 2.0 mm and 2.3 ± 1.1) to final follow-up measures (3.1 ± 2.4 mm and 3.1 ± 1.3). Shoulder abduction increased by 7.8° ± 26.8° and forward flexion decreased by 25.5° ± 32.4° after surgery. The functional results at the final follow-up were Constant 49.5 ± 18.0; American Shoulder and Elbow Surgeons 60.2 ± 27.2; Simple Shoulder Test 8.5 ± 4.6; and Disabilities of the Arm, Shoulder, and Hand 32.7 ± 12.1. The mean index value for the EuroQol Five Dimensions was 0.79, and perceived quality of life was 85.6 ± 15.4 of 100 points. 62.5% of the patients (10) were satisfied with surgery. The complication rate was 13% (2), accounting for one deep infection and one balloon migration. CONCLUSION Theoretical benefits of BSA for delaying superior humeral head translation and arthropathic changes could not be demonstrated in our series. Its functional results and satisfaction rates are low, but self-reported quality of life after surgery does not seem impaired. Complications do not occur frequently but require reintervention and endanger joint viability. LEVEL OF EVIDENCE Level IV (case series).
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Hughes JD, Davis B, Whicker E, Sprowls GR, Barrera L, Baradaran A, Sabzevari S, Burnham JM, Shah AA, Lin A. Nonarthroplasty options for massive, irreparable rotator cuff tears have improvement in range of motion and patient-reported outcomes at short-term follow-up: a systematic review. Knee Surg Sports Traumatol Arthrosc 2022; 31:1883-1902. [PMID: 35972518 DOI: 10.1007/s00167-022-07099-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 07/28/2022] [Indexed: 11/30/2022]
Abstract
PURPOSE To compare various nonarthroplasty treatment options for massive, irreparable rotator cuff tears, including allograft bridging/augmentation, debridement, partial repair, superior capsule reconstruction (SCR), subacromial balloon spacer, and tendon transfer. METHODS A comprehensive search was conducted through the PubMed, MEDLINE, and EMBASE databases for all articles pertaining to nonarthroplasty treatment options for irreparable rotator cuff tears. Inclusion criteria included manuscripts published between 2009 and 2020 with at least 1 year follow-up and Level I-IV evidence. Articles were separated into six groups: debridement, arthroscopic and open repair, allograft bridging/augmentation, SCR, subacromial balloon spacer, and tendon transfer. Data points included range of motion (external rotation, abduction, forward flexion, and internal rotation), visual analog scale (VAS) pain score, American Shoulder and Elbow Surgeons (ASES) score, Constant score, rate of revision surgery, and rate of conversion to arthroplasty. RESULTS A total of 83 studies and 3363 patients were included. All treatment options had statistically significant improvements in postoperative range of motion and patient-reported outcomes. Debridement had statistically significantly greater postoperative abduction and forward flexion range of motion, as well as better VAS pain scores, compared to the other treatment options. The SCR subgroup had the greatest improvement in ASES scores postoperatively. The overall revision rate was 7.2% among all surgical options, with the allograft bridging/augmentation group having the lowest rate of revision at 0-8.3%. The overall rate of conversion to arthroplasty was 7.2%, with debridement having the greatest rate of conversion at 15.4%. CONCLUSION All six nonarthroplasty treatment options for irreparable rotator cuff tears resulted in statistically significant improvements in range of motion and patient-reported outcomes at 1 year follow-up or more, with low rates of revision and conversion to arthroplasty. Debridement had statistically significantly greater postoperative abduction and forward flexion range of motion, as well as better VAS pain scores, compared to the other treatment options. However, these conclusions should be interpreted with caution due to the heterogeneous nature of the data, lack of prospective randomized control trials, and short-term follow-up. The findings of this study highlight the complexity of irreparable, massive rotator cuff tears, and the need for an individualized approach when treating these patients. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Jonathan D Hughes
- UPMC Freddie Fu Sports Medicine Center, Department of Orthopaedic Surgery, University of Pittsburgh, 3200 S. Water St, Pittsburgh, PA, 15203, USA.
| | - Brian Davis
- Department of Orthopaedic Surgery, Baylor College of Medicine, Houston, TX, USA
| | - Emily Whicker
- UPMC Freddie Fu Sports Medicine Center, Department of Orthopaedic Surgery, University of Pittsburgh, 3200 S. Water St, Pittsburgh, PA, 15203, USA
| | - Gregory R Sprowls
- Department of Orthopaedic Surgery, Baylor Scott and White Medical Center-Temple, Temple, TX, USA
| | - Lindsay Barrera
- Department of Orthopaedic Surgery, Baylor College of Medicine, Houston, TX, USA
| | - Ashkan Baradaran
- Department of Orthopaedic Surgery, Mashhad University of Medical Sciences, Mashhad, Khorasan Razavi, Iran
| | - Soheil Sabzevari
- UPMC Freddie Fu Sports Medicine Center, Department of Orthopaedic Surgery, University of Pittsburgh, 3200 S. Water St, Pittsburgh, PA, 15203, USA.,Department of Orthopaedic Surgery, Mashhad University of Medical Sciences, Mashhad, Khorasan Razavi, Iran
| | - Jeremy M Burnham
- Department of Orthopaedic Surgery, Ochsner Health System Baton Rouge, Baton Rouge, LA, USA
| | - Anup A Shah
- Department of Orthopaedic Surgery, Baylor College of Medicine, Houston, TX, USA.,Department of Orthopaedic Surgery, Kelsey-Seybold Clinic, Houston, TX, USA
| | - Albert Lin
- UPMC Freddie Fu Sports Medicine Center, Department of Orthopaedic Surgery, University of Pittsburgh, 3200 S. Water St, Pittsburgh, PA, 15203, USA
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Kaisidis A, Pantos P, Bochlos D. The subacromial spacer system for irreparable posterosuperior rotator cuff tears: A retrospective study of 47 patients with a two-year follow-up. Shoulder Elbow 2022; 14:76-82. [PMID: 35845623 PMCID: PMC9284253 DOI: 10.1177/1758573220960468] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 08/28/2020] [Accepted: 08/30/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND 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.
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Affiliation(s)
| | - Panagiotis Pantos
- Panagiotis Pantos, Clinic Maingau, Rotes
Kreuz, Schoeffelstrasse 2-14, Frankfurt, Hessen 60318, Germany.
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10
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Osti L, Milani L, Ferrari S, Maffulli N. Subacromial spacer implantation: an alternative to arthroscopic superior capsular reconstruction. A systematic review. Br Med Bull 2021; 139:59-72. [PMID: 34212173 DOI: 10.1093/bmb/ldab014] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/03/2021] [Indexed: 11/12/2022]
Abstract
INTRODUCTION This systematic review evaluated and compared the use of a subacromial spacer implantation (SSI) with arthroscopic superior capsular repair (ASCR) in the management of massive irreparable rotator cuff tears (MIRCTs) with an assessment of clinical and imaging outcomes. SOURCES OF DATA This systematic review was carried out following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We searched in PubMed, Medline and Embase database literature using the keywords 'subacromial spacer', 'subacromial balloon', 'subacromial device', 'arthroscopy', 'superior capsular reconstruction', 'irreparable rotator cuff tears', 'satisfaction' and 'quality of life'. AREAS OF AGREEMENT We included a total of 29 articles (14 about SSI and 15 about ASCR) dealing with outcomes, satisfaction and patients' quality of life. AREAS OF CONTROVERSY The use of a subacromial spacer showed similar results in terms of patients' satisfaction and quality of life when compared with ASCR. GROWING POINTS SSI can be implanted quickly and has a low complication rate. It can therefore be considered a good alternative for the management of MIRCTs. AREAS TIMELY FOR DEVELOPING RESEARCH The subacromial spacer is a biodegradable implant easily implanted at arthroscopy. It can lead good clinical and imaging outcomes in MIRCTs. Similarly, ASCR can be performed with either an autograft or synthetic allograft transplantation, with satisfactory results. Long-term prospective studies are needed to compare SSI and ASCR to verify their effectiveness.
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Affiliation(s)
- Leonardo Osti
- Unit of Arthroscopy and Sport Medicine, Hesperia Hospital, Via Arqua', 41125 Modena, Italy
| | - Lorenzo Milani
- Unit of Arthroscopy and Sport Medicine, Hesperia Hospital, Via Arqua', 41125 Modena, Italy.,Department of Trauma and Orthopaedic Surgery, University of Ferrara, S. Anna Hospital, Via Aldo Moro, 44124 Ferrara, Italy
| | - Silvana Ferrari
- Department of Morphology, Surgery and Experimental Medicine, University of Ferrara, Via Fossato di Mortara, 64/b, 44121 Ferrara, Italy
| | - Nicola Maffulli
- Unit of Arthroscopy and Sport Medicine, Hesperia Hospital, Via Arqua', 41125 Modena, Italy.,Department of Muscoloskeletal Disorders, University of Salerno, 84081 Salerno, Italy.,Institute of Science and Technology in Medicine, Keele University School of Medicine, Stoke on Trent ST4 7QB, UK.,Centre for Sport and Exercise Medicine, Queen Mary University of London, London E1 4NS, UK
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11
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Davey MS, Kaar K. Clinical outcomes at medium-term follow-up of sub-acromial balloon spacer insertion in the operative management of massive rotator cuff tears. Ir J Med Sci 2021; 191:1687-1691. [PMID: 34480320 DOI: 10.1007/s11845-021-02760-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 08/25/2021] [Indexed: 11/26/2022]
Abstract
INTRODUCTION The management of massive rotator cuff tears (RCTs) remains a debated topic amongst orthopaedic surgeons, with a wide spectrum of treatment options available. In recent years, the use of sub-acromial balloon spacers has emerged as an option in the management of massive RCTs. The purpose of this study is to evaluate the clinical outcomes of patients with massive RCTs who underwent arthroscopic sub-acromial balloon spacer insertion at medium-term follow-up. METHODS All consecutive patients in our institution who had undergone sub-acromial balloon spacer insertion under the senior author from 2015 to 2020 were identified and followed up via telephone survey. Patient demographics, patient-reported outcomes, complications and subsequent surgeries were all analysed using the SPSS. RESULTS Overall, 45 patients (31 males) including 36 retired (80.0%) patients, with a mean age of 70.3 ± 7.0 (40-83) years, and mean follow-up of 37.1 ± 16.4 (12-62) months were included. At final follow-up, the mean ASES score was 73.4 ± 21.8 (25-100), the mean SSV was 76.4 ± 16.0 (45-100), baseline VAS score was 0.3 ± 1.1 (0.0-6.0) and functional VAS score was 2.6 ± 2.3 (0.0-8.0), with a total of 89.9% of patients (n = 40) being satisfied at final follow-up. This series reported no intra-operative complications (0.0%), with 4 patients (8.9%) required subsequent procedures to the ispilateral shoulder post-sub-acromial balloon insertion. CONCLUSION In selected patient cohorts, the use of sub-acromial balloon spacer insertion represents a minimally invasive, viable surgical option in the management of massive rotator cuff tears, with satisfactory patient-reported outcomes, high rates of satisfaction and a low complication rate reported at medium-term follow-up. LEVEL OF EVIDENCE III; Retrospective Cohort Study.
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Affiliation(s)
- Martin S Davey
- Department of Trauma & Orthopaedics, Galway University Hospitals, Galway, Ireland.
- Royal College of Surgeons in Ireland, Dublin, Ireland.
| | - Ken Kaar
- Department of Trauma & Orthopaedics, Galway University Hospitals, Galway, Ireland
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12
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Gomes N, Fonte H, Santos S, Sousa D. Subacromial resurfacing with fascia lata autograft for irreparable cuff tears : JEO 2021 expert opinion short report & surgical technique with video. J Exp Orthop 2021; 8:64. [PMID: 34402998 PMCID: PMC8371057 DOI: 10.1186/s40634-021-00359-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Accepted: 06/02/2021] [Indexed: 11/11/2022] Open
Abstract
Massive and irreparable rotator cuff tears remain a major challenge for orthopaedic surgeons and several surgical options have been accepted for different patterns of irreparable cuff tears. However, the high-cost and technical complexity of some surgeries and the inconsistent clinical results of others, leave room for the search for surgical options that can offer a good balance between technical simplicity, a lower cost and an acceptable clinical result.The rationale behind some available techniques includes lowering the humeral head, which enables a more efficient balance of the force couples around the shoulder during rehabilitation. The interpositional arthroplasty with a biodegradable balloon, the Superior Capsule Reconstruction and, more recently, subacromial resurfacing with a dermal allograft have been presented as valid options to address that purpose.This technical note presents Subacromial Resurfacing with fascia lata as an option for the treatment of irreparable rotator cuff tears in the elderly population. Its low-cost and reasonable technical demand, along with the need for further elucidation of the ideal indications and technical optimization of other available techniques may open up room for the success of this option.
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Affiliation(s)
- Nuno Gomes
- Hospital da Luz Arrábida, Porto, Portugal
- Hospital das Forças Armadas, Porto, Portugal
- Centro Hospitalar Póvoa de Varzim - Vila do Conde, Póvoa de Varzim, Portugal
| | - Helder Fonte
- Hospital das Forças Armadas, Porto, Portugal
- Centro Hospitalar do Porto, Porto, Portugal
| | - Sara Santos
- Hospital das Forças Armadas, Porto, Portugal
- Centro Hospitalar de S. João, Porto, Portugal
| | - Duarte Sousa
- Centro Hospitalar Póvoa de Varzim - Vila do Conde, Póvoa de Varzim, Portugal
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13
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Gervasi E, Maman E, Dekel A, Markovitz E, Cautero E. Fluoroscopically Guided Subacromial Spacer Implantation for Massive Rotator Cuff Tears: Two Years of Prospective Follow-up. Orthop J Sports Med 2021; 9:2325967121993469. [PMID: 33889641 PMCID: PMC8040582 DOI: 10.1177/2325967121993469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 11/11/2020] [Indexed: 11/15/2022] Open
Abstract
Background Massive rotator cuff tears (MRCTs) are common and have been estimated to account for nearly 40% of all rotator cuff tears. An evolving strategy for management of MRCTs has been the implantation of a degradable subacromial spacer balloon that attempts to restore normal shoulder biomechanics. Purpose To assess the safety and efficacy of fluoroscopically guided balloon spacer implantation under local anesthesia in a cohort of patients with 2 years of postoperative follow-up. Study Design Case series; Level of evidence, 4. Methods The safety and efficacy of using fluoroscopically guided subacromial spacer implantation was assessed in 46 patients. Follow-up visits were scheduled according to routine clinical practice. Shoulder function was evaluated using Constant and American Shoulder and Elbow Society (ASES) scores. Results Overall, 87.5% (35/40) of patients saw clinically significant improvement in the total Constant and ASES scores from 6 weeks postoperatively, with improvement maintained up to 24 months postoperatively. Conclusion The data suggest that fluoroscopically guided subacromial spacer implantation under local anesthesia is a low-risk, clinically effective option, especially for the elderly population and those patients who have multiple comorbidities or a contraindication to general anesthesia. Patients undergoing subacromial spacer implantation for the treatment of MRCTs had satisfactory outcomes at 2-year follow-up, with a low rate of complications.
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Affiliation(s)
- Enrico Gervasi
- Shoulder Surgery Unit, Casa di Cura Giovanni XXIII Monastier di Treviso, Treviso, Italy
| | - Eran Maman
- Shoulder Unit, Division of Orthopaedic Surgery, Tel Aviv Sourasky Medical Center, Tel-Aviv, Israel
| | - Assaf Dekel
- Advanced Orthopedic Clinic, Assuta Medical Center, Tel-Aviv, Israel
| | | | - Enrico Cautero
- Shoulder Surgery Unit, Orthopedics and Traumatology Service, Ospedale S. Antonio Abate di Tolmezzo, Udine, Italy
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14
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Viswanath A, Drew S. Subacromial balloon spacer - Where are we now? J Clin Orthop Trauma 2021; 17:223-232. [PMID: 33898241 PMCID: PMC8056261 DOI: 10.1016/j.jcot.2021.03.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 03/21/2021] [Accepted: 03/22/2021] [Indexed: 12/16/2022] Open
Abstract
INTRODUCTION Rotator cuff tears are a common cause of disability and pain. The ideal treatment for truly irreparable rotator cuffs is still debated, and one recent surgical advance is the development of the subacromial balloon spacer. This review aims to clarify the current evidence and indications for this device. METHODS A comprehensive literature search was undertaken using the MeSH search terms combining "balloon spacer" and "irreparable cuff tear". A total of 20 studies using the balloon spacer as a treatment modality in more than two patients, were analysed. RESULTS A total of 513 patients were analysed, representing 83% of those initially identified as meeting the inclusion criteria. The majority of studies recommended the device, with only four suggesting it was not recommended based on their results. Notable bias was present in the studies analysed, and there were no papers providing greater than level III evidence. CONCLUSION The subacromial balloon spacer is one possible treatment option for older, low-demand patients with a full thickness rotator cuff tear involving only the supraspinatus tendon, who also have no arthritis and have preserved active elevation beyond 90°. However, the results of two large randomised prospective trials are awaited to provide satisfactory evidence regarding the use of the balloon spacer.
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Affiliation(s)
- Aparna Viswanath
- Corresponding author. 29 Brook Road, Brentwood, CM14 4PT, United Kingdom.
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15
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Liu F, Dong J, Kang Q, Zhou D, Xiong F. Subacromial balloon spacer implantation for patients with massive irreparable rotator cuff tears achieves satisfactory clinical outcomes in the short and middle of follow-up period: a meta-analysis. Knee Surg Sports Traumatol Arthrosc 2021; 29:143-153. [PMID: 31894368 DOI: 10.1007/s00167-019-05834-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Accepted: 12/13/2019] [Indexed: 02/08/2023]
Abstract
PURPOSE This meta-analysis was performed systematically to evaluate the efficacy of subacromial balloon spacers for patients with massive, irreparable rotator cuff tears. METHODS Electronic databases, including Medline/PubMed, Embase and Cochrane Library, were systematically searched to identify studies evaluating the efficacy of subacromial spacers for patients with irreparable or massive rotator cuff tears. Meta-analyses were performed to pool the outcome estimates of interest, such as the total constant score (TCS) and its sub-score (pain, activities of daily living [ADL], range of motion [ROM], and strength), Oxford shoulder score (OSS), American Shoulder and Elbow Society scores (ASES) and numeric rating scale (NRS), as well as different outcomes at different time points in the follow-up period. RESULTS Ten studies with a total of 261 patients involving 270 shoulders were deemed viable for inclusion in the meta-analysis. The combined results demonstrated significant improvements in the TCS at the final follow-up (pooled mean difference = 26.4, 95% confidence intervals [CIs] 23.3 to 29.5). A sensitivity analysis and subgroup analysis, which were implemented based on two factors, different follow-up points and sub-scores (pain, ADL, ROM, and strength), revealed a consistent trend. The combined shoulder motion results demonstrated significant improvements in the forward flexion and external rotation (0° abduction) variables rather than in the abduction and external rotation (90° abduction) variables. Additionally, significant improvements in the OSS and ASES and a decrease in the NRS were observed in the middle of the follow-up period. CONCLUSION This meta-analysis indicated that subacromial balloon spacer implantation for patients with massive irreparable rotator cuff tears may achieve satisfactory outcomes between 3 months and 3 years of follow-ups. Although the short- and middle- term effect is significant, the long-term effect needs to be confirmed by large-sample randomized controlled trial. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Fanxiao Liu
- Department of Orthopaedics, Shandong Provincial Hospital Affiliated to Shandong University, No. 324, Road Jing Wu Wei Qi, Jinan, 250021, Shandong, China
| | - Jinlei Dong
- Department of Orthopaedics, Shandong Provincial Hospital Affiliated to Shandong University, No. 324, Road Jing Wu Wei Qi, Jinan, 250021, Shandong, China
| | - Qinglin Kang
- Department of Orthopedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Yishan Road 600, Xuhui District, Shanghai, 200233, China
| | - Dongsheng Zhou
- Department of Orthopaedics, Shandong Provincial Hospital Affiliated to Shandong University, No. 324, Road Jing Wu Wei Qi, Jinan, 250021, Shandong, China
| | - Fei Xiong
- Department of Orthopedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Yishan Road 600, Xuhui District, Shanghai, 200233, China.
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16
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Johns WL, Ailaney N, Lacy K, Golladay GJ, Vanderbeck J, Kalore NV. Implantable Subacromial Balloon Spacers in Patients With Massive Irreparable Rotator Cuff Tears: A Systematic Review of Clinical, Biomechanical, and Financial Implications. Arthrosc Sports Med Rehabil 2020; 2:e855-e872. [PMID: 33364617 PMCID: PMC7754516 DOI: 10.1016/j.asmr.2020.06.011] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Accepted: 06/21/2020] [Indexed: 01/26/2023] Open
Abstract
Purpose To determine the clinical, biomechanical, and financial impact of the use of subacromial balloon spacers in the surgical management of massive, irreparable rotator cuff tears (RCTs). Methods All studies assessing the use of implantable subacromial balloon spacers for management of massive, irreparable RCTs were systematically searched. Risk of bias was assessed using Methodological Index for Non-Randomized Studies criteria. Data extraction and analysis was performed for pain and function scores, shoulder range of motion (ROM), glenohumeral contact pressure and vertical migration of humeral head, and cost. Subjective synthesis was performed with forest plots when outcomes were reported in 3 or more studies. Results In total, 19 studies met inclusion criteria for analysis; 337 patients (mean age 68 years) had 343 subacromial balloon spacer implantations. Throughout a mean follow-up of 33 months, there was significant improvement in the Total Constant Score (preoperative: 22.5-41.8; postoperative: 51.4-72.3), Oxford Shoulder Score (preoperative: 21.3-26; postoperative: 34.39-48.2), American Shoulder and Elbow Surgeons score (preoperative: 24.5-59.1; postoperative: 72.5-85.7), and shoulder ROM parameters. Subacromial balloon spacer placement resisted superior humeral head migration (range of preoperative to postoperative difference: 2.8-6.2 mm) and decreased peak subacromial pressure during shoulder ROM. Conclusions Existing literature of subacromial balloon spacers has a high risk of bias, lack of appropriate control, and low levels of evidence. A qualitative synthesis indicates that subacromial balloon spacer implantation in patients with massive irreparable RCTs is cost-effective and leads to improved function (Total Constant Score and Oxford Shoulder Score) and ROM. In cadaveric studies, subacromial balloon spacers resist superior humeral head migration and reduce subacromial pressure. The theoretical risk of biodegradation of the balloon spacer has not been substantiated in study of up to 5-years follow-up, and the risk of complications from this procedure appears to be minimal. Level of Evidence IV; Systematic review of level III-IV studies.
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Affiliation(s)
- William L Johns
- School of Medicine, Virginia Commonwealth University Health, Richmond, Virginia, USA
| | - Nikhil Ailaney
- School of Medicine, Virginia Commonwealth University Health, Richmond, Virginia, USA
| | - Kevin Lacy
- School of Medicine, Virginia Commonwealth University Health, Richmond, Virginia, USA
| | - Gregory J Golladay
- Department of Orthopaedic Surgery, Virginia Commonwealth University Health, Richmond, Virginia, USA
| | - Jennifer Vanderbeck
- Department of Orthopaedic Surgery, Virginia Commonwealth University Health, Richmond, Virginia, USA
| | - Niraj V Kalore
- Department of Orthopaedic Surgery, Virginia Commonwealth University Health, Richmond, Virginia, USA
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Burnier M, Lafosse T. Pectoralis Major and Anterior Latissimus Dorsi Transfer for Subscapularis Tears. Curr Rev Musculoskelet Med 2020; 13:725-733. [PMID: 32833188 DOI: 10.1007/s12178-020-09674-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
PURPOSE OF REVIEW Irreparable subscapularis tears represent a challenging entity, especially when they occur in younger patients with high functional demands. Tendon transfers are one of the options considered for surgical management for this pathology. The purpose of this article is to review the surgical technique and outcome of the two most common tendon transfers considered for irreparable subscapularis tears: pectoralis major and latissimus dorsi. RECENT FINDINGS Transfer of the pectoralis major has been considered for decades the transfer of choice for irreparable subscapularis tears. Recently, a series with long-term follow-up (over 18 years) supported the reduction in pain and improvement in functional scores and patient satisfaction after pectoralis major transfer. However, the range of motion and the force in internal rotation were not maintained over time. Transfer of the latissimus dorsi to the lesser tuberosity has been recently described as an alternative with a sound biomechanical rationale and encouraging short-term results. Transfer of the pectoralis major and the transfer of latissimus dorsi to the lesser tuberosity are the two transfers most commonly considered for patients with irreparable subscapularis tears. Transfer of the pectoralis major has a much longer track record. Both procedures seem to improve outcomes. Comparative studies are needed to determine the relative indications of these two procedures.
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Affiliation(s)
- Marion Burnier
- Hand and Upper Extremity Surgical Institute, Clinique du Medipole, 17 avenue Condorcet, Villeurbanne, France.
| | - Thibault Lafosse
- Alps Surgery Institute: Hand, Upper Limb, Brachial Plexus, and Microsurgery Unit (PBMA), Clinique Générale d'Annecy, Annecy, France
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18
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Matthewson G, Coady CM, Wong IHB. Rotator Cuff Reconstruction Using Fascia Lata Patch Autograft for the Nonrepairable Rotator Cuff Tear. Arthrosc Tech 2020; 9:e123-e130. [PMID: 32021785 PMCID: PMC6993264 DOI: 10.1016/j.eats.2019.09.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Accepted: 09/12/2019] [Indexed: 02/03/2023] Open
Abstract
A large to massive rotator cuff tear is a common issue that lacks reliable options to return a patient's range of motion and function when conservative treatment has failed. With up to 96% of massive rotator cuff repairs failing within the first 6 months of repair, surgeons have been searching for a reliable treatment option for this difficult subset of patients. Surgical options for massive, retracted rotator cuff tears include re-establishing the counterforce coupling of the rotator cuff with techniques such as a partial repair or superior capsular reconstruction, preventing superior humeral migration as seen with balloon spacer implantation, and eliminating pain generators with techniques such as biceps tenotomy; however, these do not reconstitute dynamic cuff control. More recently, an acellular dermal allograft, as seen in superior capsular reconstruction, has been used to reconstruct the remaining rotator cuff. We describe a technique using a fascia lata autograft to reconstruct the rotator cuff in the setting of a massive cuff tear. This is of particular importance in centers that lack the funding or institutional approval to use acellular dermal allografts that have been popularized to date.
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Affiliation(s)
| | - Catherine M. Coady
- Division of Orthopaedic Surgery, Department of Surgery, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Ivan Ho-Bun Wong
- Division of Orthopaedic Surgery, Department of Surgery, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada,Address correspondence to Ivan Ho-Bun Wong, M.D., F.R.C.S.C., M.Ac.M., Dip. Sports Med., Division of Orthopaedic Surgery, Department of Surgery, Faculty of Medicine, Dalhousie University, 5955 Veterans Memorial Lane, Room 2106 VMB, Halifax, Nova Scotia B3H 2E1, Canada.
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Jordan RW, Sharma N, Daggett M, Saithna A. The role of Superior Capsule Reconstruction in the irreparable rotator cuff tear - A systematic review. Orthop Traumatol Surg Res 2019; 105:1535-1542. [PMID: 31727588 DOI: 10.1016/j.otsr.2019.07.022] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2019] [Revised: 06/30/2019] [Accepted: 07/19/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND Irreparable rotator cuff tears in active patients provide a significant challenge and a consensus on the gold standard treatment is currently lacking. Superior capsule reconstruction (SCR) has recently been advocated and functions by providing a passive biological constraint to superior humeral head migration. The aim of this study is to systematically review the literature to evaluate the role of SCR in terms of functional outcome scores and failure rates. PATIENTS AND METHODS A review of the online databases Medline and EMBASE was conducted in accordance with the PRISMA guidelines on the 28th January 2019. Clinical studies reporting SCR using any type of graft or surgical technique were included if reporting either functional outcome scores or rate of secondary surgery. The studies were appraised using the Methodological index for non-randomised studies tool. RESULTS The search strategy identified nine studies eligible for inclusion; five reported on fascia lata autografts and four studies reported on dermal allografts. All nine studies reported significant improvement in functional scores after SCR. Rates of secondary surgery were only provided in the dermal allograft studies at short-term follow-up (mean 10.9 to 32.4months) and ranged from 0 to 18.6%. Radiological assessment revealed graft failure in 5.5 to 55% of dermal allografts and 4.2 to 36.1% of fascia lata autografts. CONCLUSION This review demonstrates that SCR is a useful treatment modality for patients with irreparable rotator cuff tears. SCR was associated with significantly improved functional outcome scores in all studies. All studies reported a preserved or increased mean AHD. The radiological graft failure rate ranged from 4.2 to 55% and the short duration of follow-up in most studies means that this remains an important concern that requires longer-term evaluation. LEVEL OF EVIDENCE IV, systematic review.
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Affiliation(s)
| | | | - Matt Daggett
- Kansas City University of Medicine and Biosciences, Missouri, USA; Sano Orthopedic Clinic, Overland Park, Kansas, USA
| | - Adnan Saithna
- Kansas City University of Medicine and Biosciences, Missouri, USA; Sano Orthopedic Clinic, Overland Park, Kansas, USA; School of Science and Technology, Nottingham Trent University, Nottingham, UK
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20
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Suh D, Ji JH, Tankshali K, Kim ES. Mid-term Clinical and Radiological Outcomes of Latissimus Dorsi Tendon Transfer in Massive Rotator Cuff Tears. Clin Shoulder Elb 2019; 22:220-226. [PMID: 33330223 PMCID: PMC7714307 DOI: 10.5397/cise.2019.22.4.220] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Revised: 10/24/2019] [Accepted: 10/27/2019] [Indexed: 11/28/2022] Open
Abstract
Background This retrospective study was undertaken to evaluate mid-term clinical and radiological outcomes of lattisimus dorsi (LD) tendon transfer in patients with irreparable massive rotator cuff tears (MRCT). We hypothesize that LD tendon transfer would provide safe and satisfactory clinical outcomes at mid-term follow-up. Methods From November 2008 to December 2016, 23 patients (57.5 ± 4.4 years; 20 male, 3 female) who underwent LD tendon transfer for massive tears, were enrolled. Inclusion criteria were irreparable MRCT. Exclusion criteria included full thickness subscapularis tear, rotator cuff arthropathy, anterosuperior rotator cuff tear, and osteoarthritis. Mean follow-up period was 4.7 ± 4.0 years (range, 2–12 years). Clinical assessment (American Shoulder and Elbow Surgeons [ASES], University of California, Los Angeles [UCLA], Simple Shoulder Test [SST]) and radiographic assessment (osteoarthritis [OA], acromiohumeral distance [AHI]) were evaluated. Results ASES, UCLA and SST scores, and range of motion (ROM), except internal rotation, improved significantly at the last follow-up (p<0.05). Also, AHI was significantly improved at the last follow-up, from 6.6 mm to 8.2 mm (p=0.008). At the final follow-up, the radiologic stages of the glenohumeral osteoarthritis were determined as stage 1 in 9 patients, stage 2 in 10 patients, stage 3 in 2 patients, and stage 4 in 2 patients. Complications were observed in 21.7% cases: 3 re-tears and 2 infections were noted in our study. Conclusions LD tendon transfer for irreparable MRCT provides satisfactory clinical outcomes at mid-term follow-up. Mild degenerative osteoarthritis (stage 1, 2) of the shoulder joint are common at the mid-term follow-up. Also, complications such as tear, infection should be considered.
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Affiliation(s)
- Dongwhan Suh
- Department of Orthopedic Surgery, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Daejeon, Korea
| | - Jong-Hun Ji
- Department of Orthopedic Surgery, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Daejeon, Korea
| | - Kirtan Tankshali
- Department of Orthopedic Surgery, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Daejeon, Korea
| | - Eung-Sic Kim
- Department of Orthopedic Surgery, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Daejeon, Korea
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Stewart RK, Kaplin L, Parada SA, Graves BR, Verma NN, Waterman BR. Outcomes of Subacromial Balloon Spacer Implantation for Massive and Irreparable Rotator Cuff Tears: A Systematic Review. Orthop J Sports Med 2019; 7:2325967119875717. [PMID: 31663007 PMCID: PMC6794659 DOI: 10.1177/2325967119875717] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Background Selection of optimal treatment for massive to irreparable rotator cuff tears (RCTs) entails a challenging decision-making process in which surgeons must consider several factors, including duration of symptoms, tear pattern, tear size, and muscle quality, as well as patient characteristics such as age, comorbidities, shoulder dominance, and activity level. Unfortunately, no clear consensus has been reached regarding optimal management. Purpose To systematically review the published literature assessing outcomes after subacromial balloon spacer implantation for treatment of massive and irreparable RCTs. Study Design Systematic review; Level of evidence, 4. Methods A comprehensive literature search was performed in September 2018 through use of MEDLINE and the Cochrane Library electronic databases. Studies were assessed for multiple outcomes of interest including Constant score, Oxford Shoulder Score (OSS), University of California Los Angeles (UCLA) Shoulder Score, complications, and patient satisfaction. Results After applying the selection criteria, 12 clinical studies were included for data extraction and analysis. In total, 291 shoulders (in 284 patients) treated with subacromial balloon spacer implantation were pooled for evaluation, with a mean follow-up of 22.9 ± 14.9 months (range, 6-60 months). Constant scores were used as an outcome metric for 267 shoulders (91.7%; 11 studies), with improvements in mean Constant score ranging from 18.5 to 49.6 points. Patient satisfaction was assessed in 105 patients (37.0%; 5 studies), with rates of patients indicating they were satisfied or very satisfied with their treatment outcome ranging from 45.8% to 100%. A total of 6 patients (2.1%) experienced complications related to balloon spacer implantation, including transient neurapraxia of the lateral antebrachial cutaneous nerve, superficial wound infection, deep wound infection, and balloon migration. Of these, 3 patients (2 balloon migration, 1 deep wound infection) required subsequent surgeries for balloon removal. Conclusion Placement of the subacromial balloon spacer is a minimally invasive, technically simple procedure with favorable patient-reported outcomes at limited short-term follow-up. However, inherent methodological limitations and patient heterogeneity between studies may impair our ability to fully characterize the longer term efficacy, particularly relative to other potential surgical options. Further prospective randomized or comparative studies are warranted to ascertain clinical outcomes of subacromial balloon spacer in the management of massive and irreparable RCTs.
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Affiliation(s)
- Russell K Stewart
- Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Lisa Kaplin
- Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Stephen A Parada
- Medical College of Georgia at Augusta University, Augusta, Georgia, USA
| | - Benjamin R Graves
- Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | | | - Brian R Waterman
- Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
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Burnier M, Elhassan BT, Sanchez-Sotelo J. Surgical Management of Irreparable Rotator Cuff Tears: What Works, What Does Not, and What Is Coming. J Bone Joint Surg Am 2019; 101:1603-1612. [PMID: 31483405 DOI: 10.2106/jbjs.18.01392] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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23
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Matsen FA, Whitson A, Jackins SE, Hsu JE. Significant improvement in patient self-assessed comfort and function at six weeks after the smooth and move procedure for shoulders with irreparable rotator cuff tears and retained active elevation. INTERNATIONAL ORTHOPAEDICS 2019; 43:1659-1667. [PMID: 30903255 DOI: 10.1007/s00264-019-04310-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Accepted: 02/12/2019] [Indexed: 01/10/2023]
Abstract
BACKGROUND It has been documented that the smooth and move procedure-smoothing the proximal humeral surface while maintaining the coracoacromial arch-can provide clinically significant long-term improvement in function for patients having irreparable rotator cuff tears with retained active elevation. This study sought to demonstrate that clinically significant gains in comfort, function, and active motion can be realized as early as 6 weeks after this procedure. METHODS We conducted a prospective cohort study of the 6-week clinical outcomes for 48 patients enrolled prior to a smooth and move procedure for irreparable rotator cuff tears. Prior rotator cuff repair had been attempted in 28 (70%). RESULTS In 40 patients with preoperative and 6-week postoperative measurements, the Simple Shoulder Test scores improved from an average of 3.4 ± 2.8 preoperatively to 5.7 ± 3.5 at 6 weeks (p < 0.001), an improvement that exceeded the published values for the minimal clinically important difference (MCID). The clinical outcomes were not worse for the 18 shoulders with irreparable tears of both the supraspinatus and infraspinatus. In 30 patients with preoperative and 6-week postoperative objective measurements of active motion, the average abduction improved from 93(± 43) to 123(± 47)° (p = 0.005) and the average flexion improved from 102(± 46) to 126(± 44)° (p = 0.023). CONCLUSIONS In addition to its previously documented long-term effectiveness for shoulders with irreparable rotator cuff tears and retained active elevation, this study demonstrates that the smooth and move procedure provides clinically significant improvement as early as 6 weeks after surgery.
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Affiliation(s)
- Frederick A Matsen
- Department of Orthopaedics and Sports Medicine, University of Washington Medical Center, 1959 NE Pacific Street, Box 356500, Seattle, WA, 98195-6500, USA.
| | - Anastasia Whitson
- Department of Orthopaedics and Sports Medicine, University of Washington Medical Center, 1959 NE Pacific Street, Box 356500, Seattle, WA, 98195-6500, USA
| | - Sarah E Jackins
- Department of Rehabilitation, University of Washington, 1959 NE Pacific St., Box 354745, Seattle, WA, 98195, USA
| | - Jason E Hsu
- Department of Orthopaedics and Sports Medicine, University of Washington Medical Center, 1959 NE Pacific Street, Box 356500, Seattle, WA, 98195-6500, USA
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Greiner S, Achenbach L. Innovationen der Rotatorenmanschettenchirurgie. ARTHROSKOPIE 2019. [DOI: 10.1007/s00142-018-0261-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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CORR Insights®: Does Distal Clavicle Resection Decrease Pain or Improve Shoulder Function in Patients With Acromioclavicular Joint Arthritis and Rotator Cuff Tears? A Meta-analysis. Clin Orthop Relat Res 2018; 476:2415-2417. [PMID: 30179961 PMCID: PMC6259888 DOI: 10.1097/corr.0000000000000441] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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Carver TJ, Kraeutler MJ, Smith JR, Bravman JT, McCarty EC. Nonarthroplasty Surgical Treatment Options for Massive, Irreparable Rotator Cuff Tears. Orthop J Sports Med 2018; 6:2325967118805385. [PMID: 30480007 PMCID: PMC6240971 DOI: 10.1177/2325967118805385] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Massive, irreparable rotator cuff tears (MIRCTs) provide a significant dilemma for orthopaedic surgeons. One treatment option for MIRCTs is reverse total shoulder arthroplasty. However, other methods of treating these massive tears have been developed. A search of the current literature on nonoperative management, arthroscopic debridement, partial repair, superior capsular reconstruction (SCR), graft interposition, balloon spacer arthroplasty, trapezius transfer, and latissimus dorsi transfer for MIRCTs was performed. Studies that described each surgical technique and reported on clinical outcomes were included in this review. Arthroscopic debridement may provide pain relief by removing damaged rotator cuff tissue, but no functional repair is performed. Partial repair has been suggested as a technique to restore shoulder functionality by repairing as much of the rotator cuff tendon as possible. This technique has demonstrated improved clinical outcomes but also fails at a significantly high rate. SCR has recently gained interest as a method to prohibit superior humeral head translation and has been met with encouraging early clinical outcomes. Graft interposition bridges the gap between the retracted tendon and humerus. Balloon spacer arthroplasty has also been recently proposed and acts to prohibit humeral head migration by placing a biodegradable saline-filled spacer between the humeral head and acromion; it has been shown to provide good clinical outcomes. Both trapezius and latissimus dorsi transfer techniques involve transferring the tendon of these respective muscles to the greater tuberosity of the humerus; these 2 techniques have shown promising restoration in shoulder function, especially in a younger, active population. Arthroscopic debridement, partial repair, SCR, graft interposition, balloon spacer arthroplasty, trapezius transfer, and latissimus dorsi transfer have all been shown to improve clinical outcomes for patients presenting with MIRCTs. Randomized controlled trials are necessary for confirming the efficacy of these procedures and to determine when each is indicated based on specific patient and anatomic factors.
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Affiliation(s)
- Trevor J Carver
- Department of Orthopedics, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Matthew J Kraeutler
- Department of Orthopedics, St Joseph's University Medical Center, Paterson, New Jersey, USA
| | - John R Smith
- Department of Orthopedics, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Jonathan T Bravman
- Department of Orthopedics, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Eric C McCarty
- Department of Orthopedics, University of Colorado School of Medicine, Aurora, Colorado, USA
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