Subacromial Balloon Spacer Implantation

Abstract

Purpose of review: Massive irreparable rotator cuff tears present a treatment challenge for the orthopedic surgeon. There is no gold standard among numerous treatment options including nonoperative management, partial repair, debridement, superior capsular reconstruction, and reverse shoulder arthroplasty. In recent years, yet another option, an implantable biodegradable subacromial balloon spacer has become available with promising early results.

Recent findings: Biomechanical studies have demonstrated that the balloon spacer effectively restores the normal humeral head position and glenohumeral joint mechanics. This device has been used in Europe since 2012 with promising clinical results. Most of the studies on this implantable balloon represent single surgeon uncontrolled case series with small numbers of patients, but they report improvements in pain and function following spacer placement, with the longest term studies reporting maintenance of improvements for up to 5 years. Certain studies have shown a benefit when the procedure is done in isolation as well as in combination with other arthroscopic procedures, such as partial rotator cuff repair. The balloon subacromial spacer is a promising new device that can be used in the treatment of patients with massive, irreparable rotator cuff tears. In our experience, patients without arthritis who have active forward elevation over 90 degrees and an intact subscapularis have the best chance of a good outcome. We recommend performing the procedure arthroscopically along with any other indicated procedures including debridement, partial repair, and biceps tenotomy or tenodesis. High-quality long-term studies are needed to better define the indications and outcomes of the implantable balloon spacer in the management of irreparable cuff tears.

Keywords: Balloon implantable spacer; Chronic rotator cuff tear; Irreparable rotator cuff tear; Nonoperative treatment of rotator cuff tears; Subacromial spacer.

Fig. 1

Schematic of the subacromial balloon spacer in position between the rotator cuff and the acromion. Illustration courtesy of OrthoSpace

Fig. 2

These images demonstrate implantation of the balloon spacer under fluoroscopic guidance. Reprinted from Gervasi et al. [14]

Fig. 3

X-ray images of the shoulder in one of our patients’ pre- (a) and post-balloon spacer implantation (b). The depression of the humeral head and increase in the acromial humeral index are evident in these side-by-side films