The experience with the use of a subacromial balloon in the treatment of patients with large, massive, irreparable rotator cuff tears

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Abstract

Background. Large, massive irreparable rotator cuff tears lead to a significant decrease in the function of the shoulder joint together with the development of a pronounced pain syndrome. Such injuries are difficult to treat, and the number of relapses, when trying to restore them, is quite high. The installation of a subacromial balloon is the method of choice for this group of patients and allows restoring the function of the shoulder joint fairly successfully. Aim: to evaluate the results of the treatment of patients with massive irreparable rotator cuff tears injuries in a prospective study from 2016 to 2018. Methods. The results of the arthroscopic treatment of large, irreparable rotator cuff injuries in 25 patients (with the average age of 67 ± 5 years) with the installation of a subacromial balloon are presented. In all the clinical cases, there was a pronounced (grades 3–4, according to the Goutallier classification) fatty dystrophy of the rotator cuff muscles (supraspinatus or in combination with subaspinatus). All the patients underwent the subacromial space release with a thorough bursectomy and subsequent installation of a subacromial balloon. Results. The average score on the UCLA scale was 14 ± 3 points (11–17) before the operation and 31±2 points (29–33) 12 months after the operation, the results were considered good and excellent. Conclusion. The results obtained allow us to evaluate the described technique as low-traumatic, simple and fast in its accomplishment, aimed at the reduction of the pain syndrome and restoration of the upper extremity function.

About the authors

Мaksim F. Lazko

Peoples’ Friendship University of Russia, Medical Institute

Author for correspondence.
Email: maxim_lazko@mail.ru
Russian Federation, Moscow

Alexey P. Prizov

Peoples’ Friendship University of Russia, Medical Institute

Email: aprizov@yandex.ru

MD, PhD, docent

Russian Federation, Moscow

Fedor L. Lazko

Peoples’ Friendship University of Russia, Medical Institute

Email: fedor_lazko@mail.ru

MD, PhD, Professor

Russian Federation, Moscow

Evgeny A. Beliak

Peoples’ Friendship University of Russia, Medical Institute

Email: belyakevgen@mail.ru

MD, PhD, assistent

Russian Federation, Moscow

Ivan G. Maglaperidze

Peoples’ Friendship University of Russia, Medical Institute

Email: v.maglapheridze@mail.ru

MD, PhD, graduate student

Russian Federation, Moscow

Aleksandr V. Kyznetsov

Peoples’ Friendship University of Russia, Medical Institute

Email: Dr.smith_a@icloud.com

MD, PhD, graduate student

Russian Federation, Moscow

Alexander A. Akhpashev

Peoples’ Friendship University of Russia, Medical Institute; Academy of Postgraduate Education under the FSBU “Federal Scientific and Clinical Center for Specialized Medical Assistance and Medical Technologies of the Federal Medical Biological Agency”

Email: akhpashev@gmail.com

MD, PhD, docent

Russian Federation, Moscow

References

  1. Bartolozzi A, Andreychik D, Ahmad S. Determinants of outcome in the treatment of rotator cuff disease. Clin Orthop Relat Res. 1994;308:90–97.
  2. Galatz LM, Ball CM, Teefey SA, et al. The outcome and repair integrity of completely arthroscopically repaired large and massive rotator cuff tears. J Bone Joint Surg Am. 2004;86(2):219–224. doi: 10.2106/00004623-200402000-00002.
  3. Burkhart SS, Barth JR, Richards DP, et al. Arthroscopic repair of massive rotator cuff tears with stage 3 and 4 fatty degeneration. Arthroscopy. 2007;23(4):347-354. doi: 10.1016/j.arthro.2006.12.012.
  4. Keener JD, Wei AS, Kim HM, et al. Revision arthroscopic rotator cuff repair: Repair integrity and clinical outcome. J Bone Joint Surg Am. 2010;92(3):590–598. doi: 10.2106/JBJS.I.00267.
  5. Abouelela AK, Abou Elsoud M. Latissimus dorsi transfer for irreparable rotator cuff tears. Egypt Orthop J. 2014;49(4):330. doi: 10.4103/1110-1148.154097.
  6. Burkhart SS, Pranckun JJ, Hartzler RU. Superior capsular reconstruction for the operatively irreparable rotator cuff tear: clinical outcomes are maintained 2 years after surgery. Arthroscopy. 2019; 36(2):373–380. doi: 10.1016/j.arthro.2019.08.035.
  7. Juhan T, Stone M, Jalali O, et al. Irreparable rotator cuff tears: Current treatment options. Orthop Rev (Pavia). 2019;11(3):8146. doi: 10.4081/or.2019.8146.
  8. Savarese E and Rocco Romeo. New Solution for Massive, Irreparable Rotator Cuff Tears: The Subacromial “Biodegradable Spacer”. Arthroscopy Techniques. 2012; 1(1) : e69-e74.
  9. Senekovic V, Poberaj B, Kovacic L, et al. The biodegradable spacer as a novel treatment modality for massive rotator cuff tears: a prospective study with 5-year follow-up. Arch Orthop Trauma Surg. 2017;137(1):95–103. doi: 10.1007/s00402-016-2603-9.
  10. Deranlot J, Herisson O, Nourissat G, et al. Arthroscopic subacromial spacer implantation in patients with massive irreparable rotator cuff tears: clinical and radiographic results of 39 retrospectives cases. Arthroscopy. 2017;33(9):1639–1644. doi: 10.1016/j.arthro.2017.03.029.
  11. Goutallier D, Postel JM, Bernageau J, et al. Fatty muscle degeneration in cuff ruptures. Pre- and postoperative evaluation by CT scan. Clin Orthop Relat Res. 1994;304:78–83.
  12. Patte D. Classification of rotator cuff lesions. Clin Orthop Relat Res. 1990;254:81–86.
  13. Outerbridge RE. The etiology of chondromalacia patellae. 1961. Clin Orthop Relat Res. 2001;(389):5–8. doi: 10.1097/00003086-200108000-00002.

Supplementary files

Supplementary Files
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1. JATS XML
2. Fig. 1. Subacromial balloon, attached to it a guidewire with a syringe filled with saline

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3. Fig. 2. Stages of preparation of the subacromial space for the subsequent installation of the balloon

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4. Fig. 3. Arthroscopic picture of balloon placement in the subacromial space

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5. Fig. 4. Average value of points on the UCLA scale in two groups of patients for the entire observation period, p = 0.03

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6. Fig. 5. A patient with an anteriorly dislocated subacromial balloon in the early postoperative period

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Copyright (c) 2020 Lazko MF, Prizov AP, Lazko FL, Beliak EA, Maglaperidze IG, Kyznetsov AV, Akhpashev AA.

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This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.

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