Subacromial Balloon Spacer for Massive Irreparable Rotator Cuff Tear is Cost-Effective in Older, Low-Demand Patients With Massive Irreparable Rotator Cuff Tear and Severe Comorbidities.

Adnan Saithna
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Abstract

The InSpace subacromial balloon spacer (Stryker, USA) is indicated for the treatment of massive irreparable rotator cuff tears. The device is placed in the subacromial space with the aim of restoring shoulder function by limiting painful acromiohumeral contact and recentering the superiorly migrated humeral head. However, controversy exists because two randomized controlled trials have produced conflicting findings with regards to efficacy. These findings, along with narrow indications have led to low utilization of the balloon amongst European and Latin American Surgeons. The controversy generated by conflicting RCTs poses challenges in the interpretation of cost effectiveness especially when the role of the balloon amongst a plethora of other options including superior capsule reconstruction (either with long head of biceps or dermal allograft), graft augmentation, tendon transfer, biologic tuberoplasty, acromial resurfacing, and reverse shoulder arthroplasty is not well defined. However, it is my opinion that the balloon has particular value in older, low-demand patients, in whom severe co-morbidities make a shorter surgical duration and quicker recovery appealing.

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用肩峰下球囊垫片治疗肩袖大面积不可修复性撕裂,对于肩袖大面积不可修复性撕裂且患有严重并发症的低需求老年患者具有成本效益。
InSpace 肩峰下球囊垫片(美国史赛克公司)适用于治疗无法修复的肩袖大面积撕裂。该装置被放置在肩峰下间隙,目的是通过限制疼痛的肩峰肱骨接触和重新定位上移的肱骨头来恢复肩关节功能。然而,由于两项随机对照试验在疗效方面得出了相互矛盾的结论,因此存在争议。这些研究结果以及狭窄的适应症导致欧洲和拉丁美洲外科医生对球囊的使用率很低。相互矛盾的 RCT 引起的争议给成本效益的解释带来了挑战,尤其是在上关节囊重建(使用肱二头肌长头或真皮同种异体移植物)、移植物增量、肌腱转移、生物结节成形术、肩峰再植术和反向肩关节成形术等大量其他方案中,球囊的作用还没有得到很好的界定。不过,我认为球囊对于年龄较大、要求不高的患者特别有价值,因为对于合并严重疾病的患者来说,手术时间短、恢复快是很有吸引力的。
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来源期刊
CiteScore
9.30
自引率
17.00%
发文量
555
审稿时长
58 days
期刊介绍: Nowhere is minimally invasive surgery explained better than in Arthroscopy, the leading peer-reviewed journal in the field. Every issue enables you to put into perspective the usefulness of the various emerging arthroscopic techniques. The advantages and disadvantages of these methods -- along with their applications in various situations -- are discussed in relation to their efficiency, efficacy and cost benefit. As a special incentive, paid subscribers also receive access to the journal expanded website.
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