Editorial Commentary: The Subacromial Balloon Spacer for Massive Irreparable Rotator Cuff Tear Demonstrates Cost-Effectiveness in Some Settings.

The InSpace subacromial balloon spacer is indicated for the treatment of massive irreparable rotator cuff tears. The device is placed in the subacromial space with the aim of restoring shoulder function by limiting painful acromiohumeral contact and recentering the superiorly migrated humeral head. However, controversy exists because 2 randomized controlled trials have produced conflicting findings with regards to efficacy. These findings, along with narrow indications, have led to low use of the balloon among European and Latin American surgeons. The controversy generated by conflicting randomized controlled trials poses challenges in the interpretation of cost effectiveness, especially when the role of the balloon among a plethora of other options including superior capsular reconstruction (either with long head of biceps or dermal allograft), graft augmentation, tendon transfer, biologic tuberoplasty, acromial resurfacing, and reverse shoulder arthroplasty is not well defined. However, it is my opinion that the balloon has particular value in older, low-demand patients, in whom severe comorbidities make a shorter surgical duration and quicker recovery appealing.