Hypothesis: In a cadaveric irreparable rotator cuff tear model, patellar tendon allograft-superior capsule reconstruction (PT-SCR) will restore glenohumeral stability and reduce subacromial contact pressures without significant graft deformation during testing.
Methods: Eight cadaveric shoulders were tested in a custom shoulder testing system. Rotational range of motion (ROM), superior translation, and subacromial contact pressure were measured in the following experimental conditions: intact rotator cuff, irreparable supraspinatus tear (massive cuff tear [MCT]), and PT-SCR.
Results: MCT and PT-SCR resulted in significantly increased total ROM at all degrees of abduction compared with the intact state (P < .001). In both 0° and 30° of glenohumeral abduction, MCT showed a significant increase in superior translation compared with the intact state (P < .001). Application of the PT-SCR resulted in a decrease of superior translation compared with MCT (P < .001). At 0° abduction/60° external rotation and 0° abduction/90° external rotation, MCT showed significantly greater peak subacromial contact pressure compared with the intact state (P < .006). At both of these positions, PT-SCR was able to reduce peak pressure to lower than or no significant difference from the intact state. There was no statistically significant change in graft thickness, length, or width after testing.
Conclusion: PT-SCR was able to reduce superior translation of the humeral head and peak subacromial contact pressure without restricting ROM. Furthermore, there was no significant graft deformation during testing. PT-SCR in this validated cadaveric model demonstrates favorable biomechanical properties and is a viable source of graft material for SCR.
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Article Synopsis
- The InSpace subacromial balloon spacer is designed to treat massive irreparable rotator cuff tears by limiting shoulder pain and improving function.
- There is ongoing debate about its effectiveness due to conflicting results from two randomized controlled trials, leading to low usage rates among surgeons in Europe and Latin America.
- The balloon may be particularly beneficial for older patients with severe co-morbidities, as it offers a quicker recovery and shorter surgical time compared to other treatment options.
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