INTRODUCTION:
The management of massive rotator cuff tears (RCTs) remains a debated topic amongst orthopaedic surgeons, with a wide spectrum of treatment options available. In recent years, the use of sub-acromial balloon spacers has emerged as an option in the management of massive RCTs. The purpose of this study is to evaluate the clinical outcomes of patients with massive RCTs who underwent arthroscopic sub-acromial balloon spacer insertion at medium-term follow-up.

METHODS:
All consecutive patients in our institution who had undergone sub-acromial balloon spacer insertion under the senior author from 2015 to 2020 were identified and followed up via telephone survey. Patient demographics, patient-reported outcomes, complications and subsequent surgeries were all analysed using the SPSS.

RESULTS:
Overall, 45 patients (31 males) including 36 retired (80.0%) patients, with a mean age of 70.3 ± 7.0 (40-83) years, and mean follow-up of 37.1 ± 16.4 (12-62) months were included. At final follow-up, the mean ASES score was 73.4 ± 21.8 (25-100), the mean SSV was 76.4 ± 16.0 (45-100), baseline VAS score was 0.3 ± 1.1 (0.0-6.0) and functional VAS score was 2.6 ± 2.3 (0.0-8.0), with a total of 89.9% of patients (n = 40) being satisfied at final follow-up. This series reported no intra-operative complications (0.0%), with 4 patients (8.9%) required subsequent procedures to the ispilateral shoulder post-sub-acromial balloon insertion.

CONCLUSION:
In selected patient cohorts, the use of sub-acromial balloon spacer insertion represents a minimally invasive, viable surgical option in the management of massive rotator cuff tears, with satisfactory patient-reported outcomes, high rates of satisfaction and a low complication rate reported at medium-term follow-up.

LEVEL OF EVIDENCE:
III; Retrospective Cohort Study.





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