Arthroscopic InSpace Stryker balloon implant as an alternative to complex rotator cuff surgery-By: Heather Stewart, PT, MSPT

Arthroscopic and open rotator cuff tendon repair surgeries are complex procedures. These

surgeries can often have a painful and difficult recovery to restore full shoulder function. The

goal of these surgeries, whether by stitching together, re-attaching, or patching the torn area, is

to have the tendons heal back onto the bone. However, this outcome isn’t always possible if

the injury and tissue quality has worsened over time or if the patients are not good surgical

candidates.

The role of the rotator cuff in the shoulder is complex in nature. Due to the many directions

the shoulder can move, the larger shoulder muscles work in coordination with the smaller

rotator cuff muscles. The cuff is composed of 4 muscles including the supraspinatus,

infraspinatus, subscapularis, and teres minor. They function to keep the ball and socket

shoulder joint in alignment so the bigger muscles of the shoulder can provide the power.

One emerging arthroscopic surgical option involves inserting a small biodegradable Stryker

balloon implant into an area in the shoulder called the subacromial space. Once inserted, the

balloon is filled with saline and serves to prevent the bones from painfully rubbing together

during movement due to a cuff tear. The spacer functions to align the shoulder to help the

muscles restore balance and strength. Post operatively, patients spend about 2 weeks in a

sling, then are able to progress to gentle stretching. More powerful movements are deferred

for 2 months. With the balloon spacer in place, the other muscles can be re-trained to take over

for the torn tendon. In about a year, the balloon is re-absorbed by the body. By this time, the

patient has progressed to a well- compensated state that can lead to regained function without

having a full rotator cuff surgery.

Patients who may benefit from this technique include those with massive and irreparable

rotator cuff tears and people over the age of 65 who have cuff degenerative tears with

moderate osteoarthritis . This procedure has been found to provide early functional

recovery, early return to range of motion, and shorter surgical times. As with all procedures,

the risks and benefits need to be considered with the surgeon.

References

1. Verma N. Srukumaran U, Roden CM, Rogusky EJ, Lapner P, Neill H, AbboudJA, (2022).

InSpace implant compared with partial repair for treatment of full-thickness massive

rotator cuff tears. J Bone Joint Surg AM. Advanced online publication. Doi.

10.2106/JBJS21.00667.

2. www.Stryker.com