Subacromial spacer

Rotator cuff injury is a common cause of shoulder pain and functional failure, in individuals above 60 years of age in particular.

The tendons that link its four muscles to the arm may be torn due to various reasons, such as a fall, mechanical injuries, degeneration and repeated overhead motions.

This may result in having difficulty moving the arm.

Rotator cuff tear may not be a life-threatening condition, but may have an impact on daily activities.

Depending on the case, the injury may be mild or serious, in particular where the tendons have been completely torn and the muscles have been detached and removed from the bone.

Serious tears are harder to deal with and pose a greater risk of relapse.

A wide range of non-pharmaceutical, pharmaceutical and surgical interventions are used to treat rotator cuff injuries, depending on the location, size (partial or total thickness) and cause of the injury.

Tears can recur after repair over time in 20-65% of the patients.

The use of conservative treatment should precede surgery.

Initially, the shoulder should be immobilized and physiotherapy should be used to prevent stiffness.

Medication aims to alleviate the symptoms, not to treat the condition.

Pain killers and orally administered anti-inflammatory drugs can help relieve the pain.

Injections of steroids and growth promoters are used for the same purpose.

How to treat rotator cuff injuries?

Invasive treatment of minor and medium tears ensures satisfactory results for a high percentage of patients.

Surgical treatment of major or massive rotator cuff tears may be technically more demanding due to tendon contraction, muscle atrophy and fatty degeneration.

The operation aims to re-attach the rotator cuff by stitching the tendon back to the humeral head.

This can be achieved by open stitching or arthroscopy, the latter being more advantageous due to the shorter recovery period and earlier return of the patient to his/her work, thanks to smaller incisions and minimum postoperative pain.

Whatever technique is deemed more appropriate for each individual patient, it aims to eliminate pain and restore the functionality of the joint.

When is subacromial spacer implantation recommended?

To alleviate pain in patients who have suffered full thickness rotator cuff tears which cannot be repaired through conservative treatment, there is a totally novel alternative to surgery: the implantation of a special balloon in the joint.

It is a balloon-shaped system designed to create a natural obstacle between the tissues and the subacromial space.

When the balloon is placed between the acromion and the humeral head, a space is created which centers the head and permits smooth and frictionless gliding.

That is, the balloon acts as a barrier between the acromion and the humeral head, imitating the function of the socket and enhancing the activity of shoulder muscles.

It is made of a biodegradable polymer that is extensively used in the medical industry (poly-L-lactide-co-ɛ-caprolactone), i.e. a material which degrades gradually until it is fully absorbed within one year approximately.

It was approved by European authorities in July 2010.

Implanting the subacromial spacer, which is the name of this special balloon, is simple.

It can be placed and developed by the use of minimally invasive techniques very fast.

The whole procedure lasts no more than 10 minutes!

Patients need not stay in hospital, but are actually dismissed on the same day.

What are the most important advantages of this novel method?

Studies carried out to assess the safety and performance of the system in patients who had suffered rotator cuff tears showed that the symptoms were alleviated approximately in 75% of them, such alleviation increasing gradually within five years from the date of implantation, when the latest evaluations were carried out.

Patients showed reduced pain, easier performance of day-to-day activities and better range of movement.

The findings showed that the implant does not have any adverse effects and the only likely risks are those associated with any shoulder arthroscopy operation.

In rare cases, synovitis or local swelling may occur, which can be treated by the use of conservative treatment.

Therefore, there is scientific evidence that the implantation of a subacromial spacer ensures easier and faster repair of the rotator cuff tear compared to other surgical alternatives.

Postoperative pain reduction enables the body to recover faster compared to the use of surgery.

Also, the rehabilitation period is shortened drastically as no major surgery or tendon repair is performed, shoulder movement is restored very quickly and the patient eventually avoids total shoulder replacement.

Dr Triantafyllopoulos is a reference surgeon for this technique in Europe.