Purpose
To synthesize and report the early clinical and radiographic outcomes associated with
subacromial spacer use in patients with massive irreparable rotator cuff tears.
Methods
A systematic search on MEDLINE, Embase, and Cochrane Library databases was performed
during February 2018. Included studies were evaluated regarding the level of evidence
and quality using the methodological index for nonrandomized studies. Patient demographics,
intraoperative findings, clinical and radiographic outcomes, and complications were
recorded for each of the included studies.
Results
Seven eligible studies including 204 shoulders from 200 patients with subacromial
spacer implantation were identified (6 Level IV studies and 1 Level III study). The
mean methodological index for nonrandomized studies score for noncomparative studies
was 11, whereas that of comparative studies was 15. The mean age of patients was 67.6 years,
and the mean reported follow-up time was 19.4 months. All patients had Goutallier
stage 3 and 4 fatty infiltration on magnetic resonance imaging. All studies reported
consistent improvement in the total Constant score or American Shoulder and Elbow
Surgeons score over the duration of follow-up. A total of 6 (3%) complications were
reported in the included studies. Two studies detailed radiographic outcomes, with
discrepant changes in the acromiohumeral interval.
Conclusions
Patients undergoing subacromial spacer implantation for the treatment of massive irreparable
rotator cuff tears have satisfactory outcomes at the 2- to 3-year follow-up with a
low rate of complications.
Level of Evidence
Level IV, systematic review of 1 Level III and 6 Level IV studies.
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Article info
Publication history
Published online: December 10, 2018
Accepted:
August 2,
2018
Received:
April 6,
2018
Footnotes
See commentary on page 615
The authors report the following potential conflicts of interest or sources of funding: B.A.P. is a consultant for Wright Medical and Acumed and receives payment for lectures and royalties from Wright Medical. Full ICMJE author disclosure forms are available for this article online, as supplementary material.
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© 2018 by the Arthroscopy Association of North America
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- Editorial Commentary: Yet Another Arrow in the Quiver for Surgical Treatment of the Rotator Cuff–Deficient Shoulder: Will It Fly Fast and Far or Fall Short Like Other Options Have?ArthroscopyVol. 35Issue 2
- PreviewRotator cuff tears are common. When indicated, surgical repair is a highly successful procedure. There are circumstances when there is not enough tendon to perform an anatomic repair because of tear size, retraction, and/or atrophy. This clinical scenario, massive irreparable rotator cuff tear, has no perfect solution. Many options exist in treating massive irreparable rotator cuff tears: partial tendon repairs, debridement, tuberoplasty, intercalary allograft repairs, tendon transfers, superior capsular reconstruction, hemiarthroplasty, arthrodesis, and reverse total shoulder arthroplasty.
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