{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T01:44:19Z","timestamp":1792115059528,"version":"4.4.0"},"reference-count":24,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T00:00:00Z","timestamp":1792022400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T00:00:00Z","timestamp":1792022400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["arthroscopyjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Arthroscopy, Sports Medicine, and Rehabil."],"abstract":"\n Purpose<\/jats:title>\n To evaluate the short\u2010term clinical outcomes of subacromial balloon implantation and concomitant procedures including subscapularis repair for irreparable posterosuperior rotator cuff tears.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n This retrospective multicenter study included patients aged \u226540\u2009years who underwent InSpace Balloon implantation between September 2021 and October 2024, with a minimum 12\u2010month follow\u2010up. Patients undergoing posterosuperior cuff repair were excluded. The primary outcome was the American Shoulder and Elbow Surgeons score. Secondary outcomes included Single Assessment Numeric Evaluation, Simple Shoulder Test, visual analog scale\u2010pain, range of motion, complications, and reoperations. Subgroup analyses compared patients with versus without subscapularis repair, those aged <65 versus \u226565, and those who underwent implantation as a revision procedure. Minimal clinically important difference and Patient Acceptable Symptom State rates were calculated using cohort\u2010specific thresholds.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Sixty patients met inclusion criteria (mean age: 68.9\u2009\u00b1\u20098.5\u2009years; mean follow\u2010up: 22.3\u2009\u00b1\u20097.9\u2009months). Statistically significant improvements were observed across all patient\u2010reported outcome measures (American Shoulder and Elbow Surgeons: 46.5\u201072.2; Single Assessment Numeric Evaluation: 37.1\u201067.7; Simple Shoulder Test: 4.6\u20107.4; visual analog scale\u2010pain: 5.2\u20102.3; all\n P<\/jats:italic>\n \u2009<\u2009.001). Range of motion improved minimally. Five patients (8%) underwent revision surgery (4 reverse shoulder arthroplasty, 1 bridging graft). Clinical outcomes did not differ significantly based on subscapularis repair. Patients aged \u226565 achieved higher American Shoulder and Elbow Surgeons scores (77.7 vs 61.2,\n P<\/jats:italic>\n \u2009<\u2009.001). There was no difference in outcomes when used as a primary or as a revision operation (\n P<\/jats:italic>\n \u2009=\u2009.74). Minimal clinically important difference was achieved in 72%; 30% met the Patient Acceptable Symptom State threshold.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n Subacromial balloon implantation provides significant short\u2010term functional and pain improvements for massive, irreparable posterosuperior rotator cuff tears, regardless of subscapularis repair. Higher clinical outcome scores were observed in patients over age 65.<\/jats:p>\n <\/jats:sec>\n \n Level of Evidence<\/jats:title>\n Level IV, retrospective therapeutic case series.<\/jats:p>\n <\/jats:sec>","DOI":"10.1002\/ars2.70101","type":"journal-article","created":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T00:48:41Z","timestamp":1792111721000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Irreparable Posterosuperior Rotator Cuff Tears Treated With InSpace Balloon With or Without Arthroscopic Subscapularis Repair: Short\u2010Term Clinical Outcomes in a Multicenter Retrospective Study"],"prefix":"10.1002","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9567-7353","authenticated-orcid":false,"given":"Yash","family":"Sewpaul","sequence":"first","affiliation":[{"name":"Lancaster University Medical School Lancaster UK"},{"name":"Department of Surgery University of Cambridge Cambridge UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-8389-5845","authenticated-orcid":false,"given":"Adam","family":"Mansour","sequence":"additional","affiliation":[{"name":"Mercy Health\u2010Cincinnati Sports Medicine Cincinnati Ohio U.S.A."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-3979-5170","authenticated-orcid":false,"given":"Alexandra","family":"Makenzie","sequence":"additional","affiliation":[{"name":"Mercy Health\u2010Cincinnati Sports Medicine Cincinnati Ohio U.S.A."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3705-9148","authenticated-orcid":false,"given":"Albert D.","family":"Mousad","sequence":"additional","affiliation":[{"name":"Levy Shoulder to Hand Center Boca Raton Florida U.S.A."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8460-4431","authenticated-orcid":false,"given":"Casey M.","family":"Beleckas","sequence":"additional","affiliation":[{"name":"Levy Shoulder to Hand Center Boca Raton Florida U.S.A."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-3992-437X","authenticated-orcid":false,"given":"Komal","family":"Singh","sequence":"additional","affiliation":[{"name":"The MORE Foundation Phoenix Arizona U.S.A."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5344-9245","authenticated-orcid":false,"given":"Samer S.","family":"Hasan","sequence":"additional","affiliation":[{"name":"Mercy Health\u2010Cincinnati Sports Medicine Cincinnati Ohio U.S.A."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1699-0841","authenticated-orcid":false,"given":"Jonathan C.","family":"Levy","sequence":"additional","affiliation":[{"name":"Levy Shoulder to Hand Center Boca Raton Florida U.S.A."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8893-135X","authenticated-orcid":false,"given":"Michael H.","family":"Amini","sequence":"additional","affiliation":[{"name":"Rothman Orthopaedic Institute Philadelphia Pennsylvania U.S.A."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1323-7213","authenticated-orcid":false,"given":"Robert U.","family":"Hartzler","sequence":"additional","affiliation":[{"name":"TSAOG Orthopaedics and Spine San Antonio Texas U.S.A."},{"name":"Burkhart Research Institute for Orthopaedics San Antonio Texas U.S.A."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,10,15]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"crossref","first-page":"47","DOI":"10.1007\/s12178-023-09879-3","article-title":"Subacromial balloon spacer for the massive irreparable cuff tear","volume":"17","author":"Sewpaul Y","year":"2024","journal-title":"Curr Rev Musculoskelet Med"},{"key":"e_1_2_9_3_1","first-page":"e2021584","article-title":"The treatment of irreparable massive rotator cuff tears with inspace balloon: Rational and medium\u2010term results","volume":"92","author":"Vecchini E","year":"2022","journal-title":"Acta Biomed"},{"key":"e_1_2_9_4_1","doi-asserted-by":"crossref","first-page":"311","DOI":"10.1007\/s00590-012-0981-4","article-title":"Prospective clinical study of a novel biodegradable sub\u2010acromial spacer in treatment of massive irreparable rotator cuff tears","volume":"23","author":"Senekovic V","year":"2013","journal-title":"Eur J Orthop Surg Traumatol"},{"key":"e_1_2_9_5_1","doi-asserted-by":"crossref","first-page":"95","DOI":"10.1007\/s00402-016-2603-9","article-title":"The biodegradable spacer as a novel treatment modality for massive rotator cuff tears: A prospective study with 5\u2010year follow\u2010up","volume":"137","author":"Senekovic V","year":"2017","journal-title":"Arch Orthop Trauma Surg"},{"key":"e_1_2_9_6_1","doi-asserted-by":"crossref","first-page":"e324","DOI":"10.1016\/j.jse.2025.05.028","article-title":"A biomechanical evaluation of rotator cuff footprint contact mechanics after rotator cuff repair with and without the augmentation of a subacromial balloon","volume":"35","author":"Fleet CT","year":"2026","journal-title":"J Shoulder Elbow Surg"},{"key":"e_1_2_9_7_1","doi-asserted-by":"crossref","first-page":"242","DOI":"10.1016\/j.arthro.2023.06.032","article-title":"Subacromial balloon spacer does not reduce the retear rate for massive rotator cuff tears: A comparative study","volume":"40","author":"Minarro JC","year":"2024","journal-title":"Arthroscopy"},{"key":"e_1_2_9_8_1","doi-asserted-by":"crossref","first-page":"1954","DOI":"10.1016\/S0140-6736(22)00652-3","article-title":"Subacromial balloon spacer for irreparable rotator cuff tears of the shoulder (START:REACTS): A group\u2010sequential, double\u2010blind, multicentre randomised controlled trial","volume":"399","author":"Metcalfe A","year":"2022","journal-title":"Lancet"},{"key":"e_1_2_9_9_1","doi-asserted-by":"crossref","first-page":"1250","DOI":"10.2106\/JBJS.21.00667","article-title":"InSpace implant compared with partial repair for the treatment of full\u2010thickness massive rotator cuff tears: A multicenter, single\u2010blinded, randomized controlled trial","volume":"104","author":"Verma N","year":"2022","journal-title":"J Bone Joint Surg Am"},{"key":"e_1_2_9_10_1","doi-asserted-by":"crossref","first-page":"1291","DOI":"10.1177\/03635465251326891","article-title":"Two\u2010year follow\u2010up of a group\u2010sequential, multicenter randomized controlled trial of a subacromial balloon spacer for irreparable rotator cuff tears of the shoulder (START:REACTS)","volume":"53","author":"Haque A","year":"2025","journal-title":"Am J Sports Med"},{"key":"e_1_2_9_11_1","first-page":"1","article-title":"Arthroscopic debridement for management of massive, irreparable rotator cuff tears: A systematic review of outcomes","volume":"2","author":"Soderlund M","year":"2022","journal-title":"JSES Rev Rep Tech"},{"key":"e_1_2_9_12_1","doi-asserted-by":"crossref","first-page":"e217","DOI":"10.3928\/01477447-20240809-01","article-title":"Clinical outcomes and re\u2010tear rates for partial arthroscopic rotator cuff repair with or without biceps augmentation for large\u2010to\u2010massive tears: A systematic review and meta\u2010analysis","volume":"47","author":"Baumann AN","year":"2024","journal-title":"Orthopedics"},{"key":"e_1_2_9_13_1","doi-asserted-by":"crossref","first-page":"109","DOI":"10.1016\/j.csm.2022.08.005","article-title":"Superior capsular reconstruction for irreparable rotator cuff tear","volume":"42","author":"Ganokroj P","year":"2023","journal-title":"Clin Sports Med"},{"key":"e_1_2_9_14_1","doi-asserted-by":"crossref","first-page":"375","DOI":"10.1016\/j.ocl.2019.03.004","article-title":"Lower trapezius tendon transfer for massive irreparable rotator cuff tears","volume":"50","author":"Stoll LE","year":"2019","journal-title":"Orthop Clin North Am"},{"key":"e_1_2_9_15_1","doi-asserted-by":"crossref","first-page":"1698","DOI":"10.1016\/j.jse.2015.04.015","article-title":"Reverse shoulder arthroplasty for massive rotator cuff tear: Risk factors for poor functional improvement","volume":"24","author":"Hartzler RU","year":"2015","journal-title":"J Shoulder Elbow 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Orthop Relat Res"},{"key":"e_1_2_9_19_1","doi-asserted-by":"crossref","first-page":"78","DOI":"10.1097\/00003086-199407000-00014","article-title":"Fatty muscle degeneration in cuff ruptures. Pre\u2010 and postoperative evaluation by CT scan","volume":"304","author":"Goutallier D","year":"1994","journal-title":"Clin Orthop Relat Res"},{"key":"e_1_2_9_20_1","doi-asserted-by":"crossref","first-page":"939","DOI":"10.1016\/j.jse.2018.10.013","article-title":"Establishing clinically significant outcome after arthroscopic rotator cuff repair","volume":"28","author":"Cvetanovich GL","year":"2019","journal-title":"J Shoulder Elbow Surg"},{"key":"e_1_2_9_21_1","doi-asserted-by":"crossref","first-page":"286","DOI":"10.1177\/03635465231155916","article-title":"High rate of clinically meaningful achievement in outcomes after subacromial balloon spacer implantation for massive irreparable rotator cuff tears: A systematic review and meta\u2010analysis","volume":"52","author":"Kunze KN","year":"2024","journal-title":"Am J Sports Med"},{"key":"e_1_2_9_22_1","doi-asserted-by":"crossref","first-page":"1577","DOI":"10.2174\/1874325001711011577","article-title":"Biceps tenotomy does not affect the functional outcomes of patients treated with spacer implantation due to massive irreparable rotator cuff tears","volume":"11","author":"Maman E","year":"2017","journal-title":"Open Orthop J"},{"key":"e_1_2_9_23_1","doi-asserted-by":"crossref","first-page":"100907","DOI":"10.1016\/j.asmr.2024.100907","article-title":"The insertion of a subacromial balloon spacer can provide symptom relief and functional improvement at a minimum 5\u2010year follow\u2010up in patients with massive irreparable rotator cuff tears","volume":"6","author":"Fares MY","year":"2024","journal-title":"Arthrosc Sports Med Rehabil"},{"key":"e_1_2_9_24_1","doi-asserted-by":"crossref","first-page":"3848","DOI":"10.1007\/s00167-018-5083-3","article-title":"The absorbable subacromial spacer for irreparable posterosuperior cuff tears has inconsistent results","volume":"26","author":"Ruiz Iban MA","year":"2018","journal-title":"Knee Surg Sports Traumatol Arthrosc"},{"key":"e_1_2_9_25_1","doi-asserted-by":"crossref","first-page":"1088","DOI":"10.1177\/03635465231168127","article-title":"Subacromial balloon placement demonstrates no advantage over debridement in the treatment of massive irreparable rotator cuff tears: A dual\u2010armed systematic review and meta\u2010analysis of over 1000 patients","volume":"52","author":"Sandler AB","year":"2024","journal-title":"Am J Sports Med"}],"container-title":["Arthroscopy, Sports Medicine, and Rehabilitation"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/arthroscopyjournals.onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/ars2.70101","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/arthroscopyjournals.onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/ars2.70101","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/arthroscopyjournals.onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/ars2.70101","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T00:48:44Z","timestamp":1792111724000},"score":1,"resource":{"primary":{"URL":"https:\/\/arthroscopyjournals.onlinelibrary.wiley.com\/doi\/10.1002\/ars2.70101"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10,15]]},"references-count":24,"alternative-id":["10.1002\/ars2.70101"],"URL":"https:\/\/doi.org\/10.1002\/ars2.70101","archive":["Portico"],"relation":{},"ISSN":["2666-061X","2666-061X"],"issn-type":[{"value":"2666-061X","type":"print"},{"value":"2666-061X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10,15]]},"assertion":[{"value":"2025-10-27","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-06-11","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-10-15","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e70101"}}