We report our medium-term outcomes of the balloon spacer in treating irreparable massive rotator cuff tears (MRCT). Twenty-two patients (17 male:5 female; mean age 68.2 years) had a balloon spacer arthroscopically inserted between September 2013–May 2017 after failing non-surgical management or rotator cuff repair. Oxford Shoulder Scores (OSS) were collected prospectively at baseline and prior to reverse total shoulder replacement (rTSR) or at most recent follow up for those with the balloon spacer still in-situ. A significant OSS improvement at mean follow-up 31.4 months (5–63) was found analysing all patients who had a balloon inserted (23.6 vs 29.6; p < 0.02). However, 6 patients (27%) converted to rTSR at a mean time of 11 months post balloon insertion with a mean OSS deterioration of 1.1. Six patients with the balloon still in-situ demonstrated either a deterioration or an OSS improvement less than the minimal clinically important difference (MCID). Three patients had an OSS improvement greater than the MCID but remained symptomatic. Seven patients (32%) had a successful clinical outcome. Patients converting to rTSR or with poor clinical outcomes were significantly older with significantly lower baseline OSS compared to those with the best outcomes. The balloon spacer is effective in a minority of patients in the medium term. The majority either convert to rTSR or remain symptomatic with the risk of failure higher in those who are older with a low baseline OSS.

Background: To determine the effect of time to repair on the outcome after an acute rotator cuff tear.Methods: We performed a retrospective analysis of prospectively collected data on patients presenting with acute rotator cuff tear to our shoulder clinic. Patient-reported outcomes were assessed using the Oxford Shoulder Score, and symptomatic retears were diagnosed by clinical assessment plus imaging.Results: Twenty patients underwent rotator cuff repair within 6 months of injury via initial referral through the Acute Shoulder Injury Clinic (early repair group; mean age, 60 years; age range, 39-77 years). Twenty age-and sex-matched patients were identified who had undergone delayed repair (618 months after injury; mean age, 60 years; age range, 40-78 years). The mean follow-up period was 10 months for the early repair group versus 11 months for the delayed repair group. Both groups had clinically significant improvements in their Oxford scores, although the early repair group had an improvement that was nearly double that of the delayed repair group (20.3 for early vs 10.4 for delayed, P = .0014). Postoperative Oxford scores were significantly higher in the early repair group (mean of 43.8 for early vs 35.8 for delayed, P = .0057). There were 2 symptomatic retears in the early repair group versus 5 in the delayed repair group.Conclusion: Our results show improved outcomes with early repair (within 6 months) of acute rotator cuff tears and support the provision of an acute shoulder injury referral clinic. (C) 2015 Journal of Shoulder and Elbow Surgery Board of Trustees.

To investigate shoulder scoring systems used in Europe and North America and how outcomes might be classified after shoulder joint replacement.All research papers published in four major journals in 2012 and 2013 were reviewed for the shoulder scoring systems used in their published papers.A method of identifying how outcomes after shoulder arthroplasty might be used to categorize patients into fair, good, very good and excellent outcomes was explored using the outcome evaluations from patients treated in our own unit.A total of 174 research articles that were published in the four journals used some form of shoulder scoring system.The outcome from shoulder arthroplasty in our unit has been evaluated using the constant score (CS) and the oxford shoulder score and these scores have been used to evaluate individual patient outcomes.CSs of < 30 = unsatisfactory; 30-39 = fair; 40-59 = good; 60-69 = very good; and 70 and over = excellent.The most popular shoulder scoring systems in North America were Simple Shoulder Test and American shoulder and elbow surgeons standard shoulder assessment form score and in Europe CS, Oxford Shoulder Score and DASH score.