The surgical options for treating irreparable tears of the supraspinatus—cuff reconstruction, tendon transfers, and shoulder replacement—are limited and complicated. But biomechanical results from a cadaveric study of 14 shoulders by Lobao et al., published in the June 5, 2019 issue of JBJS, suggest that a biodegradable balloon spacer inserted subacromially could effectively treat such insufficiencies, possibly postponing the need for more aggressive procedures.

Using an irreparable supraspinatus tear model and sophisticated instruments, the authors determined that, at postoperative time 0, the saline-inflated balloon:

• Restored intact-state glenohumeral contact pressures at most abduction angles
• Moved the humeral head inferiorly by a mean of 6.2 mm at 0° of abduction and 3.0 mm at 60°
• Increased deltoid load by 8.2% at 0° and by 11.1% at 60°.

The balloon, however, did not restore glenohumeral contact area to that of an intact shoulder.

Although the authors cite a previous clinical case series using this approach,¹ they are quick to point out that “it is not possible to correlate our findings with clinical scenarios.” Nevertheless, they say that the biomechanical data obtained from this cadaveric study “suggest that the balloon may be of benefit clinically, at least in the immediate postoperative setting.”

Reference

1. Deranlot J, Herisson O, Nourissat G, Zbili D, Werthel JD, Vigan M, Bruchou F. Arthroscopic subacromial spacer implantation in patients with massive irreparable rotator cuff tears: clinical and radiographic results of 39 retrospectives cases. Arthroscopy. 2017 Sep;33(9):1639-44. Epub 2017 Jun 8