Symptomatic Foreign Body Reaction Secondary to Subacromial Balloon Spacer Placement: A Case Report
There are many unanswered questions about the indications for and the results of the subacromial balloon spacer (SAB).
This article points out that while functional improvement, pain reduction, and high satisfaction rates have been reported in patients with massive irreparable rotator cuff tears. It as also been advocated as means of protecting a cuff repair until healing takes place.
While Singh et al demonstrated that the SAB can effectively depress the humeral head and restore glenohumeral motion in cadavers when inflated with 25 mL of saline (which is higher than the volume recommended by the manufacturer), imaging studies have failed to demonstrate that the subacromial balloon spacer can modify either the acromio-humeral distance or the Hamada classification of the shoulder, thus casting doubt on the proposed stabilizing effect of the SAB. While pain reduction has been reported with the SAB, it is difficult to know whether this is related to the SAB or to the débridement and bursectomy performed during the arthroscopy.
Although studies have suggested that the SAB resorbs one year postoperatively, clinical evidence of degradation is scant.
At this point, few major device-related complications have been reported: to date there has been one case of migration and two of synovitis with cyst formation. In the case reported here, the subacromial balloon was still present eight months postoperatively.
Its presence triggered a symptomatic foreign body reaction as proven by the histopathological analysis of the specimen.
Removal of the spacer was followed by a satisfactory outcome.
Comment: Further clinical research will be needed to define the indications, safety and outcomes of the SAB in comparison to less expensive treatments, especially in the case of irreparable cuff tears in shoulders with retained active elevation (see this link).
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