Summary

Primary cuff repairs augmented with balloon spacer implantation shows favourable outcomes. However, balloon disintegration may occur as early as at 6 weeks mark.

Abstract

Background

Massive rotator cuff tears remain a challenge for shoulder surgeons who grapple with finding an excellent surgical alternative to the conventional reverse shoulder arthroplasty. When repaired, these have a high chance of failure and poor outcomes. The Inspace balloon spacer (OrthoSpace, Kfar Saba, Israel) is made of poly-L-lactide (PLLA), a biodegradable synthetic material that aims to restore the normal shoulder biomechanics.

Hypothesis/Purpose:
We aim to explore the outcomes of patients with a majority massive rotator cuff tears treated with primary cuff repair augmented with balloon spacer.

Study Design: Retrospective Case Series

Methods

A total of 34 consecutive patients who had undergone rotator cuff repair and additional augmentation of Inspace balloon spacer at our institution from January 2019 to December 2020 were enrolled into the study. Medical records of these patients were systematically reviewed and data on age, gender, sex, BMI, inciting injury, Imaging studies, Intra-operative findings, surgical technique, post-operative progress in terms of pain, and outcome scores were examined.

Results

The mean age of our patient series is 65.3 years old, and the majority of patients (n=17, 59%) had a massive cuff tear, with the rest (41%) having large cuff tears. There was significant fatty atrophy seen in the majority of the patients ( 80%) exhibiting at least a grade 3 Goutalier fatty atrophy. Most of the patients underwent a primary cuff repair using the dual row suture bridge technique augmented with a balloon spacer(n=22, 76%). Whereas six patients underwent a superior capsular reconstruction ( 21%) and one patient underwent a partial repair ( 3%) for irreparable tears along with subacromial balloon spacer deployment. Patients in our series showed improved outcome scores at six months with a mean 11.7 point increase in Constant Score ( p=0.065), mean 7.6 point increase in UCLA score ( p<0.001), and mean 5.1 point improvement in Oxford score ( p= 0.054). Patients in our series also exhibit a significant reduction in pain scores from 7.5 to 2.7 (p<0.001). Of note, 50% of post-imaging studies (n=8) showed the absence of a balloon suggestive of disintegration at six weeks mark.

Conclusion

The use of subacromial balloon spacer on top of a primary repair has shown favourable short-term outcomes. We believe this is contributed by the effects of balloon spacer on the cuff repair, such as reducing peak compression pressure and increasing bone tendon interposition. Our series of post-operative images suggest that balloon disintegration may occur as early as six weeks.