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1. Emmanouil Brilakis
Trauma & Orthopaedic Surgeon
Athens, Greece
June 26th - 2015
Department of Shoulder Arthroscopy & Surgery

2. Emmanouil Brilakis
Trauma & Orthopaedic Surgeon
Athens, Greece
June 26th - 2015
I declare that I have no financial arrangement or
affiliation with any corporate organization offering
financial support or grant for this presentation,
nor I do have a financial interest in any
commercial product(s) or services I will
discuss in the following presentation.
Department of Shoulder Arthroscopy & Surgery

4. The use of a biodegradable sub-acromial spacer for the management of rotator cuff tears. Our experience
www.shoulder.gr

5. The use of a biodegradable sub-acromial spacer for the management of rotator cuff tears. Our experience
Biodegradable Co-polymer
(Poly L-lactide-co-ε-caprolactone)
Inflated with normal saline
Small (40 x 50 mm)
Medium (50 x 60 mm)
Large (60 x 70 mm)
www.shoulder.gr

6. The use of a biodegradable sub-acromial spacer for the management of rotator cuff tears. Our experience
www.shoulder.gr

7. The use of a biodegradable sub-acromial spacer for the management of rotator cuff tears. Our experience
www.shoulder.gr

8. The use of a biodegradable sub-acromial spacer for the management of rotator cuff tears. Our experience
www.shoulder.gr

9. The use of a biodegradable sub-acromial spacer for the management of rotator cuff tears. Our experience
How did we started with balloon?
www.shoulder.gr

10. Three individuals interaction
The use of a biodegradable sub-acromial spacer for the management of rotator cuff tears. Our experience
www.shoulder.gr

11. The use of a biodegradable sub-acromial spacer for the management of rotator cuff tears. Our experience
www.shoulder.gr

12. Ljubljana – Slovenia – April 2013
The use of a biodegradable sub-acromial spacer for the management of rotator cuff tears. Our experience
www.shoulder.gr

13. The use of a biodegradable sub-acromial spacer for the management of rotator cuff tears. Our experience
www.shoulder.gr

14. The use of a biodegradable sub-acromial spacer for the management of rotator cuff tears. Our experience
www.shoulder.gr

15. Athens – Greece – 21th October 2014
The use of a biodegradable sub-acromial spacer for the management of rotator cuff tears. Our experience
www.shoulder.gr

16. Athens – Greece – 21th October 2014
The use of a biodegradable sub-acromial spacer for the management of rotator cuff tears. Our experience
www.shoulder.gr

17. The use of a biodegradable sub-acromial spacer for the management of rotator cuff tears. Our experience
Since then…
2014
OCT MAY
2015
Short term results
7 months period
www.shoulder.gr

18. The use of a biodegradable sub-acromial spacer for the management of rotator cuff tears. Our experience
22
Balloons
Implanted 7 months
Max
Follow-up
www.shoulder.gr

19. The use of a biodegradable sub-acromial spacer for the management of rotator cuff tears. Our experience
22
Balloons
Implanted 7 months
Max
Follow-up
 10 Males (45%) – 12 Females (55%)
 Mean age of 64 ± 8.2 years (range, 48-81)
 18 shoulders (82%) were right and 4 (18%) were left
 The dominant side was involved in 18 patients (82%)
Patients
Demographics
www.shoulder.gr

20. The use of a biodegradable sub-acromial spacer for the management of rotator cuff tears. Our experience
22
Balloons
Implanted 7 months
Max
Follow-up
 18 Massive Rotator Cuff Tears
 4 Medium Size Rotator Cuff Tears
www.shoulder.gr

21. The use of a biodegradable sub-acromial spacer for the management of rotator cuff tears. Our experience
Medium Size Rotator Cuff Tears 4 cases
During the rehabilitation:
No pain (amazingly painless patients)
Very few limitations in ROM
Very satisfied patients
www.shoulder.gr

22. The use of a biodegradable sub-acromial spacer for the management of rotator cuff tears. Our experience
Medium Size Rotator Cuff Tears 4 cases
Average VAS
Rest
Motion
Night
2.0
5.5
5.8
0.0
0.2
0.0
Parameter Pre-op Post-op
www.shoulder.gr

23. The use of a biodegradable sub-acromial spacer for the management of rotator cuff tears. Our experience
Medium Size Rotator Cuff Tears 4 cases
Parameter Pre-op
ROM
FF
ER side
ER 90 abd
IR
155.0
76.3
65.0
L1
Post-op
180.0
90.0
90.0
Th10
www.shoulder.gr

24. The use of a biodegradable sub-acromial spacer for the management of rotator cuff tears. Our experience
Medium Size Rotator Cuff Tears 4 cases
Parameter Pre-op
Function
Constant
ASES
Oxford
38
60
14
Post-op
83
98
46
www.shoulder.gr

25. The use of a biodegradable sub-acromial spacer for the management of rotator cuff tears. Our experience
Female - 68yo
Medium size rotator cuff tear
Revision due to anchor disengagement
Treated by removal of the anchor and balloon implantation
Case report
www.shoulder.gr

26. The use of a biodegradable sub-acromial spacer for the management of rotator cuff tears. Our experience
Case report
6 month post-op
Re-operated because of pain and limited ROM
No pain immediately after the operation
www.shoulder.gr

27. The use of a biodegradable sub-acromial spacer for the management of rotator cuff tears. Our experience
Pain free
Full active ROM
Good Function
Constant:81, ASES: 94.99, Oxford: 47
Good strength
4Kgr – Constant
Very Satisfied
Case report
4 months post-op
www.shoulder.gr

28. The use of a biodegradable sub-acromial spacer for the management of rotator cuff tears. Our experience
6 cases with irreparable cuff tears
treated by balloon implantation only
10 cases
treated with partial repair augmented by balloon implantation
1 case
treated with complete repair augmented by balloon implantation
1 revision balloon case due to balloon failure
treated by revision balloon implantation
Massive Rotator Cuff Tears 18 cases
www.shoulder.gr

29. The use of a biodegradable sub-acromial spacer for the management of rotator cuff tears. Our experience
Massive Rotator Cuff Tears 18 cases
During the rehabilitation:
No pain or very slight pain
Very satisfied patients
Most have good active ROM
They declare that their life quality has change
www.shoulder.gr

30. The use of a biodegradable sub-acromial spacer for the management of rotator cuff tears. Our experience
Massive Rotator Cuff Tears 18 cases
Average VAS
Rest
Motion
Night
1.5
5.4
7.4
0.0
0.9
0.0
Parameter Pre-op Post-op
Average follow-up: 3.7 months
www.shoulder.gr

31. The use of a biodegradable sub-acromial spacer for the management of rotator cuff tears. Our experience
Massive Rotator Cuff Tears 18 cases
Parameter Pre-op Post-op
ROM
FF
ER side
ER 90 abd
IR
119.4
48.8
48.2
L1
145.4
63.8
54.2
Th11
Average follow-up: 3.7 months
www.shoulder.gr

32. The use of a biodegradable sub-acromial spacer for the management of rotator cuff tears. Our experience
Massive Rotator Cuff Tears 18 cases
Parameter Pre-op Post-op
Function
Constant
ASES
Oxford
44.2
50.8
28.6
51.6
81
42.2
Average follow-up: 3.7 months
www.shoulder.gr

33. The use of a biodegradable sub-acromial spacer for the management of rotator cuff tears. Our experience
Massive Rotator Cuff Tears 18 cases
All patients had:
Significant pain relief
Increased ROM
Smooth rehabilitation
www.shoulder.gr

34. The use of a biodegradable sub-acromial spacer for the management of rotator cuff tears. Our experience
Massive Rotator Cuff Tears 18 cases
It’s about QUALITY and not QUANTITY. The basic rule of life.
www.shoulder.gr

35. The use of a biodegradable sub-acromial spacer for the management of rotator cuff tears. Our experience
It’s about QUALITY
www.shoulder.gr

36. The use of a biodegradable sub-acromial spacer for the management of rotator cuff tears. Our experience
2 months post operatively
www.shoulder.gr

37. The use of a biodegradable sub-acromial spacer for the management of rotator cuff tears. Our experience
1 month post operatively
www.shoulder.gr

38. The use of a biodegradable sub-acromial spacer for the management of rotator cuff tears. Our experience
7 days post-operatively
www.shoulder.gr

39. The use of a biodegradable sub-acromial spacer for the management of rotator cuff tears. Our experience
How the balloon works ?
Pre-operatively Post-operatively
www.shoulder.gr

40. The use of a biodegradable sub-acromial spacer for the management of rotator cuff tears. Our experience
How the balloon works ?
www.shoulder.gr

41. The use of a biodegradable sub-acromial spacer for the management of rotator cuff tears. Our experience
How the balloon works ?
www.shoulder.gr

42. The use of a biodegradable sub-acromial spacer for the management of rotator cuff tears. Our experience
Male - 62yo - Doctor
Massive rotator cuff tear after shoulder dislocation (first)
Treated by arthroscopic complete repair
Revision arthroscopy (1st) due to pain and limited ROM
Anchor disengaged – failed repair
Treated by balloon implantation
Revision arthroscopy (2nd) due to balloon failure
Treated by revision balloon implantation
Case report
www.shoulder.gr

43. The use of a biodegradable sub-acromial spacer for the management of rotator cuff tears. Our experience
Case report
Blood tests were
negative for infection
www.shoulder.gr

44. The use of a biodegradable sub-acromial spacer for the management of rotator cuff tears. Our experience
Case report
www.shoulder.gr

45. The use of a biodegradable sub-acromial spacer for the management of rotator cuff tears. Our experience
Case report
www.shoulder.gr

46. The use of a biodegradable sub-acromial spacer for the management of rotator cuff tears. Our experience
Case report
During arthroscopy:
Empty balloon
Pierced at scope introduction ?
Debris and synovitis
Hundreds of white debris 1mm
in diameter inside joint and
sub-acromialy.
www.shoulder.gr

47. www.shoulder.gr
The use of a biodegradable sub-acromial spacer for the management of rotator cuff tears. Our experience

48. www.shoulder.gr
The use of a biodegradable sub-acromial spacer for the management of rotator cuff tears. Our experience
In conclusion:
Very easy technique
with
Promising initial results

49. www.shoulder.gr
The use of a biodegradable sub-acromial spacer for the management of rotator cuff tears. Our experience
…for your attentionThank you!