Normal view MARC view ISBD view

Biomechanics of Biodegradable Subacromial Balloon Spacer for Irreparable Superior Rotator Cuff Tears: Study of a Cadaveric Model.

MedStar author(s):

0021-9355

Name of journal: The Journal of bone and joint surgery. American volumeAbstract: BACKGROUND: A subacromial balloon spacer is an option to treat irreparable rotator cuff tears. We hypothesized that the balloon would restore glenohumeral contact pressure, the acromion-humeral interval, and deltoid load to intact values after a simulated irreparable supraspinatus tear in a cadaveric model.CLINICAL RELEVANCE: This study supports further investigation of the balloon spacer in comparative clinical studies of surgical options for irreparable rotator cuff tears, with clinically relevant evaluation measures and observation periods.CONCLUSIONS: In a cadaveric model of an irreparable supraspinatus tear, a balloon spacer restored intact-state glenohumeral contact pressures at most abduction angles, lowered the humeral head, and increased deltoid load at postoperative time 0.METHODS: Fourteen cadaveric shoulders (mean age at the time of death, 67.9 years) were tested using a custom test frame. In this frame, glenohumeral contact pressure, the acromion-humeral interval, and deltoid load were measured using a digital sensor, a MicroScribe, and a spring scale, respectively. Test conditions included the intact shoulder, a small supraspinatus tear, supraspinatus repair, repair plus balloon, an irreparable supraspinatus tear (rotator cable-insufficient), and an irreparable tear plus balloon. Load was applied in a simulated neutral arm position (balanced) and active shoulder abduction (unbalanced).RESULTS: When the balloon was inflated over the irreparable supraspinatus tear in the balanced condition, glenohumeral contact pressure increased by 122% (p = 0.006) compared with that for the irreparable tear at 0degree of abduction and by 94% (p = 0.046) at 60degree. In the unbalanced condition, pressure decreased in the irreparable tear condition after the balloon was inflated, restoring pressure to close to that in the intact state. The balloon did not restore glenohumeral contact area to that in the intact shoulder in either the balanced or the unbalanced condition. The irreparable tear displaced the humeral head superiorly in the unbalanced condition, decreasing the acromion-humeral interval. The balloon moved the head inferiorly by a mean (and standard error of the mean) of 6.2 +/- 1.3 mm (p < 0.001) at 0degree of abduction, 4.4 +/- 1.3 mm (p < 0.001) at 30degree, and 3.0 +/- 0.8 mm (p < 0.001) at 60degree. The balloon increased the deltoid load after an irreparable tear by 8.2% (p = 0.022) at 0degree, 12.6% (p = 0.002) at 30degree, and 11.1% (p = 0.008) at 60degree.All authors: Abboud JA, Canham RB, Lobao MH, Melvani RT, Murthi AM, Parks BGFiscal year: FY2019Digital Object Identifier:

https://dx.doi.org/10.2106/JBJS.18.00850

Date added to catalog: 2019-06-21

Holdings ( 1 )
Title notes ( 6 )

Holdings
Item type	Current library	Collection	Call number	Status	Date due	Barcode
Journal Article	MedStar Authors Catalog	Article	31169580	Available		31169580

BACKGROUND: A subacromial balloon spacer is an option to treat irreparable rotator cuff tears. We hypothesized that the balloon would restore glenohumeral contact pressure, the acromion-humeral interval, and deltoid load to intact values after a simulated irreparable supraspinatus tear in a cadaveric model.

CLINICAL RELEVANCE: This study supports further investigation of the balloon spacer in comparative clinical studies of surgical options for irreparable rotator cuff tears, with clinically relevant evaluation measures and observation periods.

CONCLUSIONS: In a cadaveric model of an irreparable supraspinatus tear, a balloon spacer restored intact-state glenohumeral contact pressures at most abduction angles, lowered the humeral head, and increased deltoid load at postoperative time 0.

METHODS: Fourteen cadaveric shoulders (mean age at the time of death, 67.9 years) were tested using a custom test frame. In this frame, glenohumeral contact pressure, the acromion-humeral interval, and deltoid load were measured using a digital sensor, a MicroScribe, and a spring scale, respectively. Test conditions included the intact shoulder, a small supraspinatus tear, supraspinatus repair, repair plus balloon, an irreparable supraspinatus tear (rotator cable-insufficient), and an irreparable tear plus balloon. Load was applied in a simulated neutral arm position (balanced) and active shoulder abduction (unbalanced).

RESULTS: When the balloon was inflated over the irreparable supraspinatus tear in the balanced condition, glenohumeral contact pressure increased by 122% (p = 0.006) compared with that for the irreparable tear at 0degree of abduction and by 94% (p = 0.046) at 60degree. In the unbalanced condition, pressure decreased in the irreparable tear condition after the balloon was inflated, restoring pressure to close to that in the intact state. The balloon did not restore glenohumeral contact area to that in the intact shoulder in either the balanced or the unbalanced condition. The irreparable tear displaced the humeral head superiorly in the unbalanced condition, decreasing the acromion-humeral interval. The balloon moved the head inferiorly by a mean (and standard error of the mean) of 6.2 +/- 1.3 mm (p < 0.001) at 0degree of abduction, 4.4 +/- 1.3 mm (p < 0.001) at 30degree, and 3.0 +/- 0.8 mm (p < 0.001) at 60degree. The balloon increased the deltoid load after an irreparable tear by 8.2% (p = 0.022) at 0degree, 12.6% (p = 0.002) at 30degree, and 11.1% (p = 0.008) at 60degree.

English