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The absorbable subacromial spacer for irreparable posterosuperior cuff tears has inconsistent results

  • Miguel Angel Ruiz Ibán
  • Rafael Lorente Moreno
  • Raquel Ruiz Díaz
  • Roselyn Álvarez Sciamanna
  • Andrea Paniagua Gonzalez
  • Alejandro Lorente Gómez
  • Jorge Díaz Heredia
Shoulder
  • 69 Downloads

Abstract

Purpose

To evaluate the 2-year results of an absorbable subacromial spacer in patients with irreparable posterosuperior rotator cuff tears.

Methods

Prospective longitudinal study of a consecutive case series of 16 subjects with irreparable tears of the posterosuperior rotator cuff in which the InSpace® subacromial spacer was arthroscopically implanted. A full clinical evaluation that included the Constant test, Simple Shoulder Test (SST) and the QuickDash questionnaire was performed preoperatively and at 12 and 24 months follow-up. The primary outcome for assessing the success of the procedure was a variable composed of a clinically relevant variation of the Constant (established in an improvement greater than 10 points) and the absence of surgical reintervention.

Results

Fifteen subjects (11 women/4 men, median age = 69.4 years [interquartile range 7.50], range 60–80 years) completed the 2-year of follow-up. According to the main evaluation criteria, only 6 patients (40%) had a successful outcome. Five subjects required reconversion to a reverse shoulder arthroplasty (at a median of 9.8 months postoperatively) due to absence of clinical improvement or worsening of symptoms. Of the ten remaining subjects, only 6 had improvements greater than 10 points in the Constant score. Despite of this, these 10 subjects had, on average, some improvement in the Constant test (preoperative Constant: median 35.0 [27.0–52.5] vs Constant at 24 months: 53.5 [55.0–84.0], significant differences p = 0.02), in the SST (3.0 [2.0–4.0] vs 6.0 [3.25–7.75], p = 0.039) and in the QuickDASH test (37.0 [33.25–40.0] vs 27.5 [20.5–32.75], p = 0.012).

Conclusions

The outcomes of the implantation of the subacromial biodegradable spacer at 2-year follow-up are not satisfactory. In this small case series only 40% of patients seem to clearly benefit from surgery. One in three required revision to a reverse shoulder arthroplasty. The described technique does not seem a reasonable alternative for the management of the majority of patients with irreparable ruptures of the rotator cuff. The indications of this device should be more clearly defined.

Level of evidence

IV.

Keywords

Subacromial spacer Massive rotator cuff tear Irreparable cuff tear Shoulder 

Notes

Funding

No funding has been obtained to perform this research.

Conflicts of interest

MRI had travel and accomodation expenses covered by Orthospace LTD. Cesarea. Israel. The rest of the authors do not have conflicts of interest.

Ethical approval

IRB approval was obtained from the Clinical investigation and Ethics Committee of the Hospital Universitario Ramon y Cajal, Madrid, Spain.

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Copyright information

© European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA) 2018

Authors and Affiliations

  • Miguel Angel Ruiz Ibán
    • 1
  • Rafael Lorente Moreno
    • 2
  • Raquel Ruiz Díaz
    • 1
  • Roselyn Álvarez Sciamanna
    • 1
  • Andrea Paniagua Gonzalez
    • 1
  • Alejandro Lorente Gómez
    • 1
  • Jorge Díaz Heredia
    • 1
  1. 1.Hospital Universitario Ramón y CajalMadridSpain
  2. 2.Hospital Infanta CristinaBadajozSpain

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