This meta-analysis was performed systematically to evaluate the efficacy of subacromial balloon spacers for patients with massive, irreparable rotator cuff tears.
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.
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.
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
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Activities of daily living
American Shoulder and Elbow Society scores
Methodological index for non-randomized studies
Numeric rating scale
Oxford shoulder score
Preferred Reporting Items for Systematic Reviews and Meta-Analyses
Rotator cuff tears
Range of motion
Reverse total shoulder arthroplasty
Superior capsular reconstruction
Total constant score
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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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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
- Subacromial balloon spacer
- Rotator cuff tear