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Treatment Options for Irreparable Rotator Cuff Tears: Subacromial Spacer

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Shoulder Arthroscopy

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Abstract

Several non-prosthetic surgical options have been introduced recently into the clinical practice for the treatment of massive irreparable rotator cuff tears. One of these options is implantation of the biodegradable spacer into the subacromial space. Spacer’s biomechanical effects are to restore force couples of the glenohumeral joint in coronal plane, to maintain the humeral head in stable position during dynamic movement and to decrease subacromial friction. It is unclear why the results last over the period of spacer biodegradation and even improve over time. One of the possible explanations is that spacer helps the patient in the immediate postoperative period to rehabilitate the shoulder and to train the appropriate muscles to establish sufficient efficiency for satisfactory shoulder function. Patients with irreparable massive rotator cuff tear suffering from impaired shoulder function, loss of active range of motion and predominant pain symptom seem to be the best candidates for this kind of treatment. The arthroscopic surgical insertion of the spacer in the subacromial space is reported in many articles to be safe, simple and with low complication rate. Clinical outcomes are generally good and comparable to the other reconstructing methods for treating irreparable massive rotator cuff tears. Recently, biodegradable subacromial spacer was also used as additional support and protection in repaired massive rotator cuff tears since the spacer can decrease humeral head upward migration, improve the humeral head position and restore functional abduction force similar to the intact condition. In the future we still need to answer some open questions about the biomechanical effect of the spacer, its long-term outcome and proper criteria for patient selection.

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Authors and Affiliations

  1. Arbor Mea Medical - Artro Center, Ljubljana, Slovenia

    Ladislav Kovačič & Vladimir Senekovič

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  1. Ladislav Kovačič
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  2. Vladimir Senekovič
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Editors and Affiliations

  1. Department of Joint and Bone Surgery, University of Brescia, Brescia, Brescia, Italy

    Giuseppe Milano

  2. Department of Orthopaedics and Traumatology, Casa di Cura Villa Valeria, Rome, Roma, Italy

    Andrea Grasso

  3. Shoulder and Upper Limb Department, St. Luke's Hospital, Bielsko-Biała, Poland

    Roman Brzóska

  4. Department of Traumatology, University Medical Centre Ljubljana, Ljubljana, Slovenia

    Ladislav Kovačič

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Kovačič, L., Senekovič, V. (2023). Treatment Options for Irreparable Rotator Cuff Tears: Subacromial Spacer. In: Milano, G., Grasso, A., Brzóska, R., Kovačič, L. (eds) Shoulder Arthroscopy. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-662-66868-9_47

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  • DOI: https://doi.org/10.1007/978-3-662-66868-9_47

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