What did the study look at?
According to the authors, large full-thickness tears of the shoulder's rotator cuff, particularly when the muscles show wasting (atrophy) and fatty change (fatty degeneration), have a high rate of re-tearing after surgery and may have poor functional results even after a well-performed repair. This article presents a technique for placing a biodegradable spacer over the repaired tendons to support the repair. It is a surgical technique article, not a comparative study of a patient group.
How was it done?
The technique uses the InSpace system, made up of an introducer and a balloon-shaped spacer of a copolymer that, according to the authors, dissolves within about 12 months. The main steps described are:
- The patient is positioned in the beach-chair position and the shoulder joint is examined through standard arthroscopic portals.
- Muscle and tendon quality are assessed, retracted tendons are released and the tear is repaired with a double-row suture bridge technique.
- Adequate space is created beneath the acromion, and spacer size is measured with an arthroscopic probe. If the measurement falls between two sizes, the smaller is chosen.
- The balloon is introduced through the lateral portal and inflated with saline to the recommended volume. The authors note that over-inflation may affect blood supply to the cuff and cause pain.
- Finally, the shoulder is moved passively through its full range to check that the spacer stays in place.
In the authors' table, the indication is given as massive tears in patients over 65 in whom the head of the upper arm bone can be covered after adequate release.
What did it find?
The article does not include a patient study comparing outcomes numerically. The authors state that midterm MRI results are promising for both restoration of the space beneath the acromion and patient satisfaction, and show MRI images at 6 months. They also observed on one-year MRI that, once the spacer had dissolved, a bursa-like soft tissue had formed around the repaired cuff.
The authors suggest that the balloon reduces friction during arm elevation by keeping the humeral head lower. However, they also state that it is unclear how long the spacer stays inflated and why pain and function scores keep improving after it dissolves.
The authors' conclusion
According to the authors, the biodegradable subacromial spacer is a promising device that can be used after anatomical repair, especially in patients with massive rotator cuff tears in whom proper and reliable fixation of the tear is a challenge.
Limitations
The authors note that how long the spacer remains inflated, and the mechanism of improvement after it dissolves, are unclear. As a technique description, the article does not provide comparative data on the method's effectiveness.
Reference
Bozkurt M, Akkaya M, Gürsoy S, Isik C. 2015. Augmented Fixation With Biodegradable Subacromial Spacer After Repair of Massive Rotator Cuff Tear. Arthroscopy Techniques 4(5):e471-e474. Licence: CC BY-NC-ND 4.0.
DOI: 10.1016/j.eats.2015.04.007
Free full text: PubMed Central
This article summarises a published scientific paper for general information; it does not replace an examination or a personal medical assessment. Please consult your doctor about your symptoms.
