Mercy Medical Center shoulder specialist, Dr. Gregory Gasbarro talks about fixing rotator cuff injuries with something called “balloon spacers.”
Interview conducted by Ivanhoe Broadcast News in 2023.
You said sometimes that bone really pushes up, it gets way out of whack. How does that happen?
GASBARRO: Well, the rotator cuff, one of it’s main functions is to stabilize the ball and the socket. So if you lose especially that top rotator cuff tendon off the top of the ball, instead of that bone going to the socket up over your head and the ball migrate up in the joint and hit that bone that’s above, that can cause a lot of pain. So the idea is to redirect that bone back to the socket with this balloon spacer, and I said we’ll see how that turns out as far as long-term results.
Because it’s brand new the FDA just approved, right?
GASBARRO: Yeah, it was approved at our hospital and in 2022, the FDA approved it slightly before that. The data from Europe was encouraging and there was a group in the United States out of Philadelphia that had about a two year review of the literature using this device. And there’s good early results, but you always want to take those early results with a grain of salt and see if they’re going to hold up over time, especially in your own hands when you start using this new technology.
The balloon space are space between what and what?
GASBARRO: So, it’s between that arm bone ball of the shoulder joint and the acromion which is part of your wing bone, your scapula. So it goes right in between those two bones and you put it in the outside part of your shoulder. You put it in as an unfilled balloon, think of it that way and then you pump fluids salient into it and it props open that space.
How do you determine, in the O.R., how much saline to put when you’re at that point?
GASBARRO: There’s technique guides and there’s different sizes that you can use. So you have different measurements you can make when you’re in the operating room and each individual shoulder, you pick the size that you want. And depending on the size is how much do you push into the balloon to make sure it’s nice and stable and doesn’t pop for instance.
Is this much better for the patient, in terms of outcome?
GASBARRO: Not sure. So it’s quicker, it’s more efficient in the operating room. But the other options for rotator cuff tears that you can’t fix necessarily fully or to partially repair them, augment them with different things like dermal allografts, skin from a cadaver that’s sterilized and processed. The biceps tendon is another thing that we’re using now to augment repairs. So there’s lots of different things that you can do and the outcomes vary depending on who’s doing them, how long they follow their patients? What outcomes they’re looking at? So I don’t think there’s anything we can say definitively if this balloon is going to be an advantage over this other techniques, quite yet.
When you are in the O.R. using them, what technique will you use? Is it robotic?
GASBARRO: It’s arthroscopic. So you put small holes around the shoulder about the size of your pinky nail, but a camera into the joint and use tools in and out of the other holes to manipulate this balloon or the rotator cuff, whatever you’re fixing. So it’s a camera surgery.
Can you describe the old method compared to something like that?
GASBARRO: Balloon wasn’t around then so this is brand new technology in the 2020s. All the rotator cuff repairs pre 2000s, even into the 1980s a lot of open techniques. So an open incision instead of these small little incisions we make now, for the most part shoulder surgeons around the country are doing arthroscopic techniques for a lot of these repairs and new technology coming out. So, this is a rough model of the shoulder, so this would be the socket, this would be the arm bone and the ball. The red thing would be the biceps tendon, which is a tendon in the front of the shoulder. And then this would be – this green thing would be the rotator cuff which attaches to the side of the ball there. And with a rotator cuff tear, this pulls off and is ripped off of this part of the bone. Oftentimes you’re going to have a biceps problem occur with it. And if this tendon is no longer repairable and it’s a younger patient and maybe you don’t want to do something more invasive, like a reverse shoulder replacement and you want to try to preserve their joint. There’s lots of options to do that. So you can partially repair it, you can repair some of it, you could use a tendon transfers. So take a muscle that’s outside of the shoulder joint and redirected into the shoulder to supplement the function that’s lost by what’s torn. You could put a graft in this area of skin, that’s called the superior capsular reconstruction. It’s a cadaver graph that acts to basically redirect the balls that wants to go up in the joint back to the socket. You can use the biceps tendon to do that same thing to reinforce your repair or you can use these balloon spacers. So the idea is if you lose that top rotator cuff tendon, when you go to raise your arm over your head the ball goes up in the joint as opposed to towards the socket, when it goes up it can bump the bone that’s above which would be my fingers, the acromion. So if you put that balloon spacer in between that area it acts like a reverse trampoline almost, so as you go to activate your arm to go over your head and it goes up in the joint it hits this thing and it redirects it to the socket, and then you’ve got a good base and a fulcrum for the rest of your movement over your head.
How do these rotator cuffs affect someome who likes pitching baseballs?
GASBARRO: It depends, so a lot of them are wear and tear on your shoulder, from years of use it could be an overhead labor, it could be a former athlete, it could also be traumatic injury. So a patient that has a fall reaches for something in an awkward position, fills a big pop in their shoulder has new pain, new overhead weakness. So you get to see a huge variety of this and my shoulder clinic, and you take care of patients anywhere from usually their late 30s up until 70s, 80s years old with shoulder problems. The purpose of the balloon spacer would be if the green portion here is the torn rotator cuff and it’s off and it’s not repairable. The ball no longer has a restraint as it goes up and it can’t get redirected back to the socket. So there’s another bone that’s up here called the acromion, and you put the spacer under that bone and over this bone which is the arm bone. And as the ball wants to migrate up because the rotator cuffs torn, it can’t go up and hit this bone and it redirects the ball, the balloon does to the socket to give you a fulcrum to go up over your head to improve overhead motion.
END OF INTERVIEW
This information is intended for additional research purposes only. It is not to be used as a prescription or advice from Ivanhoe Broadcast News, Inc. or any medical professional interviewed. Ivanhoe Broadcast News, Inc. assumes no responsibility for the depth or accuracy of physician statements. Procedures or medicines apply to different people and medical factors; always consult your physician on medical matters.
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