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Subacromial balloon spacer implantation for patients with massive irreparable rotator cuff tears achieves satisfactory clinical outcomes in the short and middle of follow-up period: a meta-analysis

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Abstract

Purpose

This meta-analysis was performed systematically to evaluate the efficacy of subacromial balloon spacers for patients with massive, irreparable rotator cuff tears.

Methods

Electronic databases, including Medline/PubMed, Embase and Cochrane Library, were systematically searched to identify studies evaluating the efficacy of subacromial spacers for patients with irreparable or massive rotator cuff tears. Meta-analyses were performed to pool the outcome estimates of interest, such as the total constant score (TCS) and its sub-score (pain, activities of daily living [ADL], range of motion [ROM], and strength), Oxford shoulder score (OSS), American Shoulder and Elbow Society scores (ASES) and numeric rating scale (NRS), as well as different outcomes at different time points in the follow-up period.

Results

Ten studies with a total of 261 patients involving 270 shoulders were deemed viable for inclusion in the meta-analysis. The combined results demonstrated significant improvements in the TCS at the final follow-up (pooled mean difference = 26.4, 95% confidence intervals [CIs] 23.3 to 29.5). A sensitivity analysis and subgroup analysis, which were implemented based on two factors, different follow-up points and sub-scores (pain, ADL, ROM, and strength), revealed a consistent trend. The combined shoulder motion results demonstrated significant improvements in the forward flexion and external rotation (0° abduction) variables rather than in the abduction and external rotation (90° abduction) variables. Additionally, significant improvements in the OSS and ASES and a decrease in the NRS were observed in the middle of the follow-up period.

Conclusion

This meta-analysis indicated that subacromial balloon spacer implantation for patients with massive irreparable rotator cuff tears may achieve satisfactory outcomes between 3 months and 3 years of follow-ups. Although the short- and middle- term effect is significant, the long-term effect needs to be confirmed by large-sample randomized controlled trial.

Level of evidence

IV.

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Abbreviations

ADL:

Activities of daily living

ASES:

American Shoulder and Elbow Society scores

CIs:

Confidence intervals

ISB:

InSpace™ balloon

MD:

Mean difference

MINORS:

Methodological index for non-randomized studies

NRS:

Numeric rating scale

OSS:

Oxford shoulder score

PRISMA:

Preferred Reporting Items for Systematic Reviews and Meta-Analyses

RCTs:

Rotator cuff tears

ROM:

Range of motion

RTSA:

Reverse total shoulder arthroplasty

SCR:

Superior capsular reconstruction

SD:

Standard deviation

TCS:

Total constant score

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Acknowledgements

This study was supported by China Scholarship Council (CSC) which funded two of the authors (Fanxiao Liu, CSC, NO.: 201808080126; Fei Xiong, CSC, NO.: 201706920036) and the Key R & D program in Shandong Province (Jinlei Dong, NO.: 2016GSF201214).

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All authors contributed substantially to conception and design, or acquisition of data, or analysis and interpretation of data, drafted the article or revised it critically for important intellectual content, provided final approval of the version to be published, and agreed to act as guarantor of the work (ensuring that questions related to any part of the work are appropriately investigated and resolved).

Correspondence to Fei Xiong.

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Liu, F., Dong, J., Kang, Q. et al. Subacromial balloon spacer implantation for patients with massive irreparable rotator cuff tears achieves satisfactory clinical outcomes in the short and middle of follow-up period: a meta-analysis. Knee Surg Sports Traumatol Arthrosc (2020) doi:10.1007/s00167-019-05834-3

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Keywords

  • Subacromial balloon spacer
  • Rotator cuff tear
  • Meta-analysis