Subacromial Spacer

  • Enrique Salas
  • Guillermo Arce
  • Gustavo Matheus


Rotator cuff tears (RCT), either massive (M) or irreparable (I), can pose significant challenges to orthopedic surgeons, as they are frequently linked to high failure rates. There are several surgical options to deal with such cases including reverse shoulder arthroplasty, superior capsular reconstruction, tendon transfer, arthroscopic debridement with biceps tenotomy and subacromial decompression, partial cuff repairs, grafts, patches, as well as tuberoplasty. Each option has advantages and disadvantages, and the ultimate treatment must be customized according to the type of injury as well as the specific patient needs. Recently the use of subacromial spacers provided encouraging results, emerging as a valuable option for the treatment of both MRCT and IRCT.


Subacromial Spacer Balloon Massive Irreparable Cuff tears 


  1. 1.
    Longo UG, Franceschetti E, Petrillo S, Maffulli N, Denaro V. Latissimus dorsi tendon transfer for massive irreparable rotator cuff tears: a systematic review. Sports Med Arthrosc. 2011;19:428–37.CrossRefGoogle Scholar
  2. 2.
    Senekovic V, Poberaj B, Kovacic L, Mikek M, Adar E, Markovitz E, Maman E, Dekel A. The biodegradable spacer as a novel modality for massive rotator cuff tears: a prospective study with 5-year follow up. Arch Orthop Trauma Surg.
  3. 3.
    Gervasi E, Cautero E, Dekel A. Fluoroscopy-guided implantation of subacromial “biodegradable spacer” using local anesthesia in patients with irreparable rotator cuff tear. Arthrosc Tech. 2014;3(4):e455–8.CrossRefGoogle Scholar
  4. 4.
    Senekovic V, Poberaj B, Kovacic L, Mikek M, Adar E, Dekel A. Prospective clinical study of a novel biodegradable sub-acromial spacer in treatment of massive irreparable rotator cuff tears. Eur J Orthop Surg Traumatol.
  5. 5.
    Rosa D, Balato G, Ciaramella G, Di Donato S, Auletta N, Andolfi C. Treatment of massive irreparable rotator cuff tears through biodegradable subacromial. InSpace balloon. Rosa et al. BMC Surg. 2013;13(Suppl 1):A43. Scholar
  6. 6.
    Deranlot J, Herisson O, Nourissat G, Zbili D, Werthel JD, Vigan M, Bruchou F. Arthroscopic subacromial spacer implantation in patients with massive irreparable rotator cuff tears: clinical and radiographic results of 39 retrospectives cases. Arthroscopy. 2017;33:1639–44.CrossRefGoogle Scholar
  7. 7.
    Savarese E, Romeo R. New solution for massive, irreparable rotator cuff tears: the subacromial “biodegradable spacer”. Arthrosc Tech.
  8. 8.
    Holschen M, Brand F, Agneskirchner JD. Subacromial spacer implantation for massive rotator cuff tears. Clinical outcome of arthroscopically treated patients. Obere Extrem. 2017;12(1):38–45. Springer Medizin Verlag, BerlinCrossRefPubMedGoogle Scholar
  9. 9.
    Bozkurt M, Akkaya M, Gursoy S, Isik C. Augmented fixation with biodegradable subacromial spacer after repair of massive rotator cuff tear. Arthrosc Tech. 2015;4(5):e471–4. Scholar
  10. 10.
    Gervasi E. IS-CL-05: InSpace in local anesthesia. Preliminary study results 1 Sep 2015.Google Scholar
  11. 11.
    Szöllösy G, Rosso C, Fogerty S, Petkin K, Lafosse L. Subacromial spacer placement for protection of rotator cuff repair. Arthrosc Tech. 2014;3(5):e605–9. Scholar
  12. 12.
    Denard PJ, Ladermann A, Brady PC, et al. Pseudoparalysis from a massive rotator cuff tear is reliably reversed with an arthroscopic rotator cuff repair in patients without preoperative glenohumeral arthritis. Am J Sports Med. 2015;43:2373–8.CrossRefGoogle Scholar
  13. 13.
    Kokubu T, Mifune Y, Inui A, Kuroda R. Arthroscopic rotator cuff repair with graft augmentation of fascia lata for large and massive tears. Arthrosc Tech. 2016;5:e1235–8.CrossRefGoogle Scholar
  14. 14.
    Burkhart SS, Barth JR, Richards DP, Zlatkin MB, Larsen M. Arthroscopic repair of massive rotator cuff tears with stage 3 and 4 fatty degeneration. Arthroscopy. 2007;23(4):347–54.CrossRefGoogle Scholar
  15. 15.
    Kartus J-T. Editorial commentary: irreparable rotator cuff tears might be surgically treatable after all. Arthroscopy. 2017;33(9):1645. Scholar
  16. 16.
    Anley CM, Chan SKL, Snow M. Arthroscopic treatment options for irreparable rotator cuff tears of the shoulder. World J Orthop. 2014;5(5):557–65. Scholar
  17. 17.
    Denard P, Brady P, Adams C, Tokish J, Burkhart S. Preliminary results of superior capsule reconstruction with dermal allograft. Arthroscopy. 2018;34(1):93–9.CrossRefGoogle Scholar
  18. 18.
    Gasparini C. Rotture massive della cufa dei rotatori: quale spazio per lo spaziatore subacromiale? L Orthopedico Traumatologo.Google Scholar
  19. 19.
    Calvo A. The subacromial spacer. Symposium revision rotator cuff repair. Shanghai: ISAKOS Biannual Congress; 2017.Google Scholar

Copyright information

© ISAKOS 2019

Authors and Affiliations

  • Enrique Salas
    • 1
  • Guillermo Arce
    • 2
  • Gustavo Matheus
    • 3
  1. 1.Department of Orthopaedic SurgeryCentro Medico Docente La TrinidadCaracasVenezuela
  2. 2.Department of Orthopaedic SurgeryInstituto Argentino de Diagnostico y TratamientoBuenos AiresArgentina
  3. 3.Department of Orthopaedic surgeryClinica SantrixCaracasVenezuela

Personalised recommendations