Editorial Commentary: Subacromial Balloon Spacer Is an Alternative to Rotator Cuff Repair in Older, Lower-Demand Patients Who Prioritize Pain Relief and Faster Recovery Over Strength Restoration.

The subacromial balloon spacer was originally designed to treat massive irreparable rotator cuff tears in patients with pain but preserved function, and favorable results have been reported. However, surgeons have expanded its application to include use as an adjunct for salvage procedures such as superior capsular reconstruction and tendon transfer, as a delivery device for steroids or biologics, and as an augmentation in the setting of primary or revision rotator cuff tear. When adapting technology to new techniques, one must ask, What is the basis by which we can expect success? In rotator cuff repair, the technology of anchor, suture, and repair configurations is such that mechanical failure is rare. Failure occurs because of lack of biological healing. It is hard to imagine how the balloon may improve biology. In addition, an intact tendon is not required for acceptable patient function or pain relief. The balloon spacer is an alternative to repair in properly selected older, lower-demand patients who prioritize pain relief over strength restoration in exchange for faster recovery.