scholarly journals AB0967 OBESITY IMPACTS SURGICAL REPAIR OF ROTATOR CUFF TEAR IN A LOW-INCOME POPULATION

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 1779.2-1779
Author(s):  
C. Silva ◽  
N. Mourão ◽  
J. Landim ◽  
L. Da Rocha ◽  
M. Lacerda ◽  
...  
Keyword(s):  
Los Angeles ◽  
Rotator Cuff ◽  
Low Income ◽  
Surgical Repair ◽  
Smoking Status ◽  
Rotator Cuff Tears ◽  
Patient Reported ◽  
The Impact ◽  
Shoulder Score

Background:Rotator cuff tears (RCT) rank high among causes of shoulder pain in primary care. Surgical repair of RCT is indicated when judged refractory to clinical treatment. Comorbidities and environmental issues may impact the surgical result of RCT repair.Objectives:to determine the impact of Obesity and Smoking in the outcome of low-income patients subjected to RCT repair.Methods:Low-income (<5500,00 US$ annualpib per capta*) patients living in Fortaleza-CE, Brazil were prospectively (2016-2018) evaluated in the Orthopedic and Rheumatology Services of the Hospital Geral de Fortaleza. Demographics and clinical data focusing Obesity (BMI >/≤ 30) and Smoking status (present/absent) were registered. Pain (0 – 10 cm VAS) and functional shoulder score evaluation by the University of California at Los Angeles Shoulder Score (UCLA) and American Shoulder and Elbow Surgeons (ASES) scoring systems following at least 2 years post-operative follow-up were recorded.Results:Thirty-nine individuals, 60.9±7.1 years-old, 30 female (68.3%) with 5.1 ± 1.9 years follow-up were evaluated; 21 (44.7%) were Smokers and 12 (25.5%) Obese (BMI >30). Other comorbidities included 16 arterial hypertension, 18 dyslipidemia, 17 osteoarthritis, 4 rheumatoid arthritis, 1 gout. Pain VAS values were 5.1 ± 2.6 vs 3.1 ± 2.8 in Obese vs Non-Obese (p=0.03) and 4 ± 2.8 vs 3.37 ± 2.99 in Smokers vs Non-Smokers (p=0.26), respectively. UCLA was 22.4 ± 8.2 vs. 28.79 ± 5.6 in Obese vs Non-Obese (p=0.004) and 26.2 ± 6.5 vs. 27.75 ± 7.18 (p=0.25) in Smokers vs. Non-smokers, respectively. ASES was 47.89 ± 28.3 vs. 68.1 ± 25.78 (p=0.021) in Obese vs. Non-obese and 58.98 ± 26.69 vs 65.3 ± 28.1 (p=0.243) in Smokers vs Non-Smokers, respectively.Conclusion:Using Patient Reported Outcome instruments, these long-term data show that Obesity negatively impacts the outcome of surgical repair of RCT in low-income patients. Smoking status was apparently irrelevant but the number of cigarettes smoked daily was not considered. Emphasis on weight reduction is a practical, affordable though hard to implement measure that could improve surgical results when repairing RCT.References:*https://pt.wikipedia.org/wiki/Lista_de_munic%C3%ADpios_do_Brasil_por_PIBDisclosure of Interests:Christine Silva: None declared, Natalia Mourão: None declared, Joaquim Landim: None declared, Leila da Rocha: None declared, Marco Lacerda: None declared, Airton Rocha Speakers bureau: Not related to the present work

scholarly journals The Impact of Smoking on Clinical Results Following the Rotator Cuff and Biceps Tendon Complex Arthroscopic Surgery

2021 ◽  
Vol 10 (4) ◽  
pp. 599
Author(s):  
Jan Zabrzyński ◽  
Gazi Huri ◽  
Maciej Gagat ◽  
Łukasz Łapaj ◽  
Alper Yataganbaba ◽  
...  
Keyword(s):  
Rotator Cuff ◽  
Functional Outcomes ◽  
Shoulder Arthroscopy ◽  
Smoking Status ◽  
Biceps Tendon ◽  
Arthroscopic Surgery ◽  
Rotator Cuff Tears ◽  
Shoulder Injuries ◽  
The Impact

The purpose of this study was to investigate the association of smoking and functional outcomes after arthroscopic treatment of complex shoulder injuries: rotator cuff tears (RCTs) with biceps tendon (LHBT) tears. This retrospective case-control study has been conducted on a cohort of patients who underwent shoulder arthroscopy between 2015 and 2017 due to complex injury treatment. The outcomes were assessed using the American Shoulder and Elbow Surgeons Score (ASES), the University of California at Los Angeles (UCLA) Shoulder Score, need for non-steroid anti-inflammatory drugs (NSAIDs) consumption and the visual analog scale (VAS). Complications and changes in smoking status were also noted. A cohort of 59 patients underwent shoulder arthroscopy, due to complex LHBT pathology and RCTs, and were enrolled in the final follow-up examination; with mean duration of 26.03 months. According to smoking status, 27 of patients were classified as smokers, and the remaining 32 were non-smokers. In the examined cohort, 36 patients underwent the LHBT tenotomy and 23 tenodesis. We observed a relationship between smoking status and distribution of various RCTs (p < 0.0001). The mean postoperative ASES and UCLA scores were 80.81 and 30.18 in the smoker’s group and 84.06 and 30.93 in the non-smoker’s group, respectively. There were no statistically significant differences in pre/postoperative ASES and postoperative UCLA scores between smokers and non-smokers (p > 0.05). The VAS was significantly lower in the non-smokers’ group (p = 0.0021). Multi-tendon injuries of the shoulder are a serious challenge for surgeons, and to obtain an excellent functional outcome, we need to limit the negative risk factors, including smoking. Furthermore, there is a significant association between smoking and the occurrence of massive rotator cuff tears, and the pain level measured by the VAS. Simultaneous surgical treatment of RC and LHBT lesions in the smoker population allowed us to obtain the functional outcomes approximated to non-smokers in the long-term follow-up. Of course, we cannot assert that smoking is the real cause of all complications, however, we may assume that this is a very important, negative factor in shoulder arthroscopy.

scholarly journals Surgeon-operated ultrasonography in a one-stop shoulder clinic

2011 ◽  
Vol 93 (7) ◽  
pp. 528-531 ◽  
Author(s):  
R Seagger ◽  
T Bunker ◽  
P Hamer
Keyword(s):  
Rotator Cuff ◽  
Surgical Repair ◽  
Rotator Cuff Tears ◽  
Financial Cost ◽  
Time Saving ◽  
One Stop ◽  
Group A ◽  
Group B ◽  
Portable Ultrasonography

INTRODUCTION Nearly 1 in 40 of the population seeks medical advice related to a shoulder problem every year. The majority pertain to rotator cuff pathology. Prior to intervention in such patients it is imperative to define whether the tendons are intact or torn. Ultrasonography has become an essential adjunct to clinical assessment in diagnosing rotator cuff tears. This study was designed to investigate if a surgeon using a portable ultrasonography machine in a one-stop shoulder clinic could significantly reduce the time a patient waited from initial outpatient presentation to the end of the treatment episode (be it surgery, injection or conservative management). METHODS A total of 77 patients were allocated to one of two groups: Group A, consisting of 37 patients who were assessed and had ultrasonography as outpatients, and Group B, consisting of 40 patients who were assessed and referred for departmental ultrasonography where appropriate. Three clear outcome groups were defined: those who required surgical repair, those who had irreparable tears and those who declined surgery. RESULTS For all outcomes (surgery, irreparable tears and conservative treatment), the patients in Group A all completed their clinical episodes significantly quicker than those in Group B (p<0.02). As well as the time saving benefits, there was a substantial financial saving for Group A. By performing ultrasonography in the outpatients department, those patients avoided the requirement of departmental imaging (£120) and subsequent follow-up appointments (£73) to discuss results and management, resulting in a saving of nearly £200 per patient. CONCLUSIONS The use of a portable ultrasonography machine by an orthopaedic surgeon can significantly reduce the time to treatment and the financial cost for patients with rotator cuff tears.

scholarly journals Arthroscopic Superior Capsular Reconstruction in Males Provides Superior Outcomes to Reverse Total Shoulder or Debridement for Irreparable Rotator Cuff Tears

2018 ◽  
Vol 6 (7_suppl4) ◽  
pp. 2325967118S0010
Author(s):  
John M. Tokish ◽  
Michael J. Kissenberth ◽  
Ellen Shanley ◽  
Stefan John Tolan ◽  
Kyle J. Adams ◽  
...  
Keyword(s):  
Rotator Cuff ◽  
Patient Reported Outcomes ◽  
Rotator Cuff Tears ◽  
Preliminary Results ◽  
Biceps Tenotomy ◽  
Superior Capsular Reconstruction ◽  
Patient Reported ◽  
Male Patients ◽  
Reverse Total Shoulder

Objectives: Early results following arthroscopic superior capsular reconstruction(SCR) in patients with massive, irreparable rotator cuff tears are promising. However, no studies have compared patient reported outcomes between SCR or reverse total shoulder(rTSA) and rotator cuff debridement for these patients. Therefore, the purpose of this study was to compare 1-year outcomes between patients with massive irreparable rotator cuff tears who underwent a SCR, rTSA, or rotator cuff debridement with a concurrent biceps tenotomy or tenodesis. Methods: Patients(n=63) who underwent either SCR(n=21), rTSA(21), or cuff debridement(n=21) and biceps tenotomy or tenodesis for a massive, irreparable rotator cuff tear treated with a minimum 1-year follow up were retrospectively reviewed. Age, sex, BMI, smoking status, Charlson Index, Hamada classification, and ASES scores were recorded and compared using a multivariate ANOVA were used to compare between surgical approaches. A Chi Square analyses were used to compare sex distribution and the Charlson Deyo Index between groups (α=0.05). Results: Overall, patients across the 3 groups were not statistically different in age or follow up ASES score at minimum 14 month follow up ( P> 0.05). There was a significant interaction effect between surgery group and sex (P=0.02) on ASES score but not age ( P=0.08). Univariate F tests revealed that male patients who received an SCR displayed a 10-14% better outcome at follow up compared to other groups (Table 1) which exceeds the reported ASES score MCID. Conclusion: Our results show comparable results across surgical options for massive irreparable cuff tears with good patient reported outcomes. Male patients displayed clinically important greater ASES scores at 1 year follow up. Future studies should evaluate these preliminary results to assess if these preliminary results hold up at longer follow up times.

scholarly journals Arthroscopic lower trapezius tendon transfer provides equivalent outcomes to latissimus dorsi transfer in the treatment of massive posterosuperior rotator cuff tears

2020 ◽  
Vol 5 (5) ◽  
pp. 269-274
Author(s):  
Jarret M Woodmass ◽  
Eric R Wagner ◽  
Michelle J Chang ◽  
Kathryn M Welp ◽  
Florian Grubhofer ◽  
...  
Keyword(s):  
Rotator Cuff ◽  
Latissimus Dorsi ◽  
Tendon Transfer ◽  
Adhesive Capsulitis ◽  
Rotator Cuff Tears ◽  
Forward Flexion ◽  
Patient Reported ◽  
Cutibacterium Acnes ◽  
Lower Trapezius

ObjectivesThe purpose of this study is to compare early postoperative recovery following open and arthroscopic-assisted latissimus dorsi tendon (aa-LDT) transfer to arthroscopic-assisted lower trapezius tendon (aa-LTT) transfer for patients with massive irreparable posterosuperior rotator cuff pathology.MethodsA multicentre retrospective analysis comparing the postoperative outcomes after open LDT, arthroscopic-assisted LDT (aa-LDT) or arthroscopic-assisted LTT (aa-LTT) was performed. Active range of motion and patient-reported subjective outcomes were reported preoperatively and postoperatively. Overall, there were 10 patients who underwent open LDT transfer, 16 aaLDT transfers and 8 aa-LTT transfers with mean age of 55±3, 57±6 and 53±13, respectively. Mean follow-up was 22±10 months.ResultsArthroscopic-assisted LDT had significantly improved postoperative forward flexion (85–124, p<0.003) and external rotation (29–38, p<0.005), whereas aa-LTT had significantly improved postoperative forward flexion (101–146, p<0.04). Arthroscopic-assisted LDT and aa-LTT transfers improved American Shoulder and Elbow Surgeons (ASES) Shoulder Function scores and Single Assessment Numeric Evaluation (SANE) at 2 years (p<0.03). Arthroscopic-assisted LTT compared with open LDT demonstrated significantly improved ASES Shoulder Index score (20.0 vs 12.6; 84.8 vs 55.6) and visual analogue scale (VAS) (0.66 vs 4.14; 1.17 vs 3.88) at postoperative 6 months and 2 years, respectively. Arthroscopic-assisted LDT transfer compared with open LDT had improved VAS at 6 months (0.66 vs 2.11, p<0.05). In total, 6 (17.6%) complications were noted. These included two infections with Cutibacterium acnes, two axillary nerve injuries, complex regional pain syndrome and a postsurgical adhesive capsulitis.ConclusionsArthroscopic-assisted LDT and aa-LTT transfers provided improvement in pain and function at 2-year follow-up. The aa-LTT transfer provided significantly improved outcomes at 2 years compared with the open-LDT (latissimus dorsi tendon transfer) transfer. This study demonstrates superiority of arthroscopic-assisted tendon transfer techniques over traditional open techniques while establishing the aa-LTT transfer as a safe and effective alternative in the management of massive irreparable rotator cuff tears.Level of evidenceIV.

scholarly journals Ultrasound and Functional Assessment of Transtendinous Repairs of Partial-Thickness Articular-Sided Rotator Cuff Tears

2017 ◽  
Vol 5 (3) ◽  
pp. 232596711769737 ◽  
Author(s):  
Roger V. Ostrander ◽  
Jeffrey M. Klauser ◽  
Sanjay Menon ◽  
Joshua G. Hackel
Keyword(s):  
Los Angeles ◽  
Rotator Cuff ◽  
Functional Outcomes ◽  
Case Series ◽  
Rotator Cuff Tears ◽  
High Grade ◽  
Partial Thickness ◽  
Ultrasound Evaluation ◽  
Functional Scores

Background: Partial-thickness articular-sided rotator cuff tears are a frequent source of shoulder pain. Despite conservative measures, some patients continue to be symptomatic and require surgical management. However, there is some controversy as to which surgical approach results in the best outcomes for grade 3 tears. Hypothesis/Purpose: The purpose of this study was to evaluate repair integrity and the clinical results of patients treated with transtendinous repair of high-grade partial-thickness articular-sided rotator cuff tears. Our hypothesis was that transtendinous repairs would result in reliable healing and acceptable functional outcomes. Study Design: Case series; Level of evidence, 4. Methods: Twenty patients with a minimum follow-up of 2 years were included in the study. All patients underwent arthroscopic repair of high-grade partial-thickness rotator cuff tears utilizing a transtendinous technique by a single surgeon. At latest follow-up, the repair integrity was evaluated using ultrasound imaging, and functional scores were calculated. Results: Ultrasound evaluation demonstrated that 18 of 20 patients had complete healing with a normal-appearing rotator cuff. Two patients had a minor residual partial tear. Sixteen of 20 patients had no pain on visual analog scale. Four patients complained of mild intermittent residual pain. All patients were rated as “excellent” by both the University of California at Los Angeles Shoulder Score and the Simple Shoulder Test. Conclusion: The transtendon technique for the repair of articular-sided high-grade partial rotator cuff tears results in reliable tendon healing and excellent functional outcomes.

scholarly journals Comparison of Superior Capsular Reconstruction and Partial Infraspinatus Repair: A Matched-Pair Analysis of Irreparable Rotator Cuff Tears

2021 ◽  
Vol 9 (2) ◽  
pp. 232596712098426
Author(s):  
Stefan Greiner ◽  
Max Kaeaeb ◽  
Andreas Voss ◽  
Robert Lawton ◽  
Pushkar Bhide ◽  
...  
Keyword(s):  
Rotator Cuff ◽  
Constant Score ◽  
Rotator Cuff Tears ◽  
Matched Pair ◽  
Dash Score ◽  
Western Ontario Rotator Cuff ◽  
Superior Capsular Reconstruction ◽  
Patient Reported ◽  
The Mean

Background: Superior capsular reconstruction (SCR) represents a new option for the treatment of irreparable rotator cuff tears. Purpose/Hypothesis: This study aimed to evaluate the clinical and radiologic outcomes of SCR and compare them with the outcomes of partial repair (PR) of the infraspinatus tendon. The hypothesis was that there would be no significant differences between the clinical and radiologic outcome parameters of SCR and PR after a minimum follow-up of 2 years. Study Design: Cohort study; Level of evidence, 3. Methods: Of 21 patients who underwent SCR, 20 patients were matched in a 1:1 ratio according to sex, age, and tear configuration with 20 of 60 patients who had undergone PR; all patients were prospectively evaluated for a minimum follow-up of 2 years. The investigated outcome measures included the Constant score; Western Ontario Rotator Cuff (WORC) index; Disabilities of the Arm, Shoulder and Hand (DASH) score; and radiologic analysis of acromiohumeral distance (AHD) and humeral head centralization (HHC). Results: There were no differences in the demographic data between the SCR and PR groups. The mean age of both groups was 62.3 years (range, 47-79 years), the mean tear configuration was Bateman 3.0 and Patte 2.8, and the mean follow-up period was 29.4 months (range, 24-53 months). At final follow-up, no significant differences were seen between the SCR and PR groups with regard to Constant score (77.1 vs 82.7), age- and sex-adapted Constant score (85.5% vs 91.4%), DASH score (15.6 vs 7.8), or WORC index (81.1 vs 90.4). No significant differences in the AHD or HHC were seen between the groups. The reoperation rate was 4.8% (1/21) in the SCR cohort and 15% (9/60) in the PR cohort. Conclusion: Both SCR and PR resulted in significant improvements in patient-reported outcomes at 2-year follow-up, with no significant differences in clinical outcomes between the 2 techniques. Further follow-up is needed to determine whether there are long-term differences in HHC and development of cuff tear arthropathy. Further investigations should also focus on the cost-effectiveness of the respective procedures.

scholarly journals Surgical outcome following rotator cuff tear repair in a low-income population. Impact of obesity and smoking

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Christine M. M. Silva ◽  
Natália M. Mourão ◽  
Leila N. da Rocha ◽  
Joaquim I. V. D. Landim ◽  
Hermano A. L. Rocha ◽  
...  
Keyword(s):  
Rotator Cuff ◽  
Low Income ◽  
Smoking Status ◽  
Fatty Infiltration ◽  
Obese Patients ◽  
Full Thickness ◽  
Low Income Population ◽  
Cuff Tear ◽  
Tendon Retraction

Abstract Background Comorbidities and socioeconomic issues impact outcome of rotator cuff tear (RCT) repair. There are no data on RCT repair outcome from developing regions. We determined the impact of obesity and smoking following RCT repair in a low-income population. Methods This is a retrospective case series. Forty-seven shoulders of 42 patients subjected to open or arthroscopic repair of a RCT with a minimum of 2 years follow-up were cross-sectionally evaluated. Patients were seen in the Orthopaedic Service of the Hospital Geral de Fortaleza-CE, Brazil between March and September 2018. RCT were classified as partial or full-thickness lesions. Fatty infiltration (Goutallier) and tendon retraction (Patte) were recorded as well as obesity (BMI > 30), literacy [>/≤ 8 school years (SY)] and smoking status 6 months prior to surgery (present/absent). Outcomes included pain (visual analogue scale; VAS, 0–10 cm), range of motion [active forward flexion and external rotation (ER)], UCLA and ASES scoring. Results Patients were 59.9 ± 7.4 years-old, 35(74.4%) female with 19 (17.1–30.2 IQR) median of months from diagnosis to surgery and 25 median months of follow-up (26.9–34.0 IQR); over 90% declared < 900.00 US$ monthly family income and two-thirds had ≤8 SY. Forty patients (85.1%) had full-thickness tears, 7 (14.9%) had Goutallier ≥3 and over 80% had < Patte III stage. Outcomes were similar regardless of fatty infiltration or tendon retraction staging. There were 17 (36.1%) smokers and 13 (27.6%) obese patients. Outcome was similar when comparing obese vs non-obese patients. Smokers had more pain (P = 0.043) and less ER (P = 0.029) with a trend towards worse UCLA and ASES scores as compared to non-smokers though differences did not achieve minimal clinically important difference (MCID) proposed for surgical RCT treatment. After adjusting for obesity, VAS and ER values in smokers were no longer significant (P = 0.2474 and 0.4872, respectively). Conclusions Our data document outcomes following RCT repair in a low-income population. Smoking status but not obesity impacted RCT repair outcome though not reaching MCID for surgical treatment.

scholarly journals Surgical repairs of the Rotator Cuff Tears

2017 ◽  
Vol 8 (1) ◽  
Author(s):  
S M H Jafri ◽  
W A Khan ◽  
M Pervaiz ◽  
A Ghaffar ◽  
S Raziq
Keyword(s):  
Pain Relief ◽  
Rotator Cuff ◽  
Old Age ◽  
Rotator Cuff Repair ◽  
Surgical Repair ◽  
Senior Author ◽  
Rotator Cuff Tears ◽  
Cuff Repair ◽  
Cause Of Pain

Evaluation of 15 cases who underwent surgical rotator cuff repair is presented. This study extends from 1995 to 2001. Cases operated by senior author have been included in this study. The follow up ranges from 9 months to 4 years. Evaluation includes study as regard to pain relief, range of motion and strength achieved after surgery. In all cases acromion- plasty was done. Rotator cuff problem is a well-know cause of pain and disability in shoulder especially in old age. Good results after surgical repair of rupture rotator cuff have been well documented. To our best knowledge this is the first study in this country about results of surgical rotator cuff repair.

scholarly journals Effect of arthroscopic acromioplasty on reducing critical shoulder angle: a protocol for a prospective randomized clinical trial

2020 ◽  
Vol 21 (1) ◽  
Author(s):  
Yi Long ◽  
Jingyi Hou ◽  
Yiyong Tang ◽  
Fangqi Li ◽  
Menglei Yu ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Los Angeles ◽  
Rotator Cuff ◽  
Visual Analog Scale Score ◽  
Large Degree ◽  
Number System ◽  
Rotator Cuff Tears ◽  
Critical Shoulder Angle ◽  
The Impact ◽  
Shoulder Angle

Abstract Background The critical shoulder angle (CSA), which helps to predict patients who are at risk of rotator cuff tears (RCTs) with large degree and who are susceptible to osteoarthritis with low angle, has been identified as one of the most vital acromial parameters; anterolateral and lateral acromioplasties have been proven to be valid ways to reduce CSA. However, no study has compared the effect of different acromioplasties on the reduction of the large CSA (≥33°) clinically. Additionally, either anterolateral or lateral acromioplasty could not precisely correct large CSAs to a favorable range (30–33°) in each patient. Thus, we will propose a novel precise acromioplasty technique for the purpose of reducing CSA accurately and effectively, and compare the effectiveness of different acromioplasties on the reduction of the CSA. Methods A total of 60 RCT patients who have indications for arthroscopic rotator cuff repair and with pre-operative CSA ≥33° will be recruited in outpatient center of Sun Yat-sen Memorial Hospital. Eligible participants will be randomly allocated to Group A (anterolateral acromioplasty), Group B (lateral acromioplasty) or Group C (precise acromioplasty) via a random, computer-generated number system. Three surgical plans will be made for each participant respectively by one professional surgeon according to the results of randomization allocation. The post-operative CSA will be measured 2 days post-operation. Follow-up will be maintained at 3, 6, and 12 months after surgery including the visual analog scale score, the University of California at Los Angeles score, the Constant Shoulder Score and the American Shoulder and Elbow Surgeon Shoulder Assessment Form. Finally, all outcomes will be assessed by two researchers who are blinded to the recruitment and allocation. Discussion This is the first clinical trial to evaluate the impact of different acromioplasties on the reduction of the CSA. Additionally, this study will provide a new precise acromioplasty technique, which is a novel precision and individualized treatment to prevent degenerative RCTs by reducing the CSA. Trial registration ChiCTR2000032343. Registered on April 26th, 2020.

scholarly journals Outcomes of Subacromial Balloon Spacer Implantation for Massive and Irreparable Rotator Cuff Tears: A Systematic Review

2019 ◽  
Vol 7 (10) ◽  
pp. 232596711987571 ◽  
Author(s):  
Russell K. Stewart ◽  
Lisa Kaplin ◽  
Stephen A. Parada ◽  
Benjamin R. Graves ◽  
Nikhil N. Verma ◽  
...  
Keyword(s):  
Systematic Review ◽  
Patient Satisfaction ◽  
Rotator Cuff ◽  
Wound Infection ◽  
Constant Score ◽  
Rotator Cuff Tears ◽  
Deep Wound Infection ◽  
Deep Wound ◽  
Shoulder Score

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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