Editor’s note: The following article is a review of a video available via the AAOS Orthopaedic Video Theater. AAOS Now will routinely review “OVT plus” videos, which are vetted by topic experts and offer CME. For more information, visit www.aaos.org/videos/.

Large, retracted rotator cuff tears are an increasingly common problem faced by shoulder surgeons and one with no single solution that fits all patients. This video describes a new and innovative technique to add to the armamentarium of options for treating this difficult problem. Currently more than 18 million Americans are treated annually for shoulder pain. Many of these patients will also have rotator cuff tears. Large, retracted tears of the rotator cuff can be difficult to manage. While nonoperative regimens such as physical therapy and cortisone injections are helpful, these measures do not work for all patients. For patients who do not benefit from nonoperative treatment and have large, retracted tears, surgical options include partial or complete cuff repair, debridement, reverse arthroplasty, tendon transfer, and superior capsular reconstruction.

Many retracted tears are associated with muscle atrophy and fatty degeneration that is visualized on MRI. Balloon arthroplasty represents a new option for treatment of this issue. As seen in Figs. 1 and 2, the video from Dr. Horneff and colleagues demonstrates that the balloon resists the superior pull of the deltoid muscle and assists to centralize the humeral head in the glenoid. In several cadaver studies, the balloon restored glenohumeral positioning through the normal arc of motion.

The balloon is filled with saline and consists of a biodegradable substance that is absorbed in three to six months. The authors describe several advantages to balloon arthroplasty over other options. There is limited healing time and a short rehabilitation timeline. The procedure is technically easy and requires only two arthroscopic portals. It is contraindicated in patients who have advanced arthritis, active infection, or a subscapularis tear or tears of the posterior inferior rotator cuff.

The procedure is performed in the beach chair position. After a thorough inspection of the shoulder, a limited bursectomy is performed. The defect is measured with a probe and calibrated to one of three balloon sizes. The balloon is assembled on the back table and then inserted and inflated in the subacromial space. Positioning is verified and the insertion device is detached. Postinsertion stability is evaluated.

The postoperative rehabilitation program is simple.

• 0 to 4 weeks: Use an abductions sling and avoid weight-bearing.
• 4 to 8 weeks: Remove sling, start physical therapy, and limit weight-bearing to 3 lbs.
• 8 to 12 weeks: Advance to full strengthening.

The video presenters discuss a range of studies that describe similar experiences in European and American studies. All studies show improved Constant scores and high levels of function and pain-related improvement. The complication rate was low and only a small percentage of patients required balloon removal or additional surgery in the short one- to two-year follow-up period. Balloon arthroplasty demonstrated similar results to superior capsular reconstruction but was a much simpler procedure with a more rapid recovery time.

Balloon arthroplasty is a promising procedure that has a place in the range of options in caring for nonrepairable rotator cuff tears. It is a new procedure and long-term studies, beyond three years, have not been performed. The device is also pricey, which may impact its use in certain centers.

Visit www.aaos.org/videos/ to view this award-winning title and more than 1,200 other videos from across orthopaedic topics, institutions, practice management, and industry.

Thomas Fleeter, MD, MBA, FAAOS, is in private practice in Reston, Va, with Town Center Orthopedics. He is a member of the AAOS Now Editorial Board and chair of the AAOS Committee on Professionalism.

Video Details

Title: Subacromial Balloon Arthroplasty for irreparable rotator cuff tear
Authors: John G. Horneff, MD, FAAOS; Joseph A. Abboud, MD, FAAOS; Manan Sunil Patel, BA
Published: Aug. 25, 2021
Time: 23:45
CME: 0.75 credits
Tags: Shoulder and Elbow, Rotator Cuff, Arthroplasty, Biomechanics