Subacromial Spacer Placement for Protection of Rotator Cuff Repair Gregor Szöllösy, M.D., Claudio Rosso, M.D., Simon Fogerty, M.B.Ch.B., Kalojan Petkin, M.D., Laurent Lafosse, M.D.  Arthroscopy Techniques  Volume 3, Issue 5, Pages e605-e609 (October 2014) DOI: 10.1016/j.eats.2014.06.017 Copyright © 2014 Arthroscopy Association of North America Terms and Conditions

Fig 1 Operating room setup and spacer introduction. A right shoulder is shown with the patient in the beach-chair position; the arm is under forward traction of 2.5 kg (not shown). (A) The assistant's fingers seal the anterior portals because no trocars are used. From the cannula outflow, the irrigation fluid is drawn to fill a syringe (BD Plastipak). (B) The portal (no trocars are used) is enlarged by passing an open Pean clamp (Landanger) from inside out. (C) The camera is in the lateral portal, and a small joint probe (ConMed Shutt) is inserted through the dorsal portal. The subacromial space size is measured from the anterior tip of the acromion to the interior opening of the posterior portal. (D) The laser marks on the probe are at a 5-mm distance from each other. (E) The surgeon holds the device in his left hand and has already placed the spacer in the subacromial space. The syringe is mounted directly on the introducer handle. (F) The spacer is placed correctly in the middle of the subacromial space under direct arthroscopic control. Arthroscopy Techniques 2014 3, e605-e609DOI: (10.1016/j.eats.2014.06.017) Copyright © 2014 Arthroscopy Association of North America Terms and Conditions

Fig 2 Balloon placement and testing. A right shoulder is shown with the patient in the beach-chair position and traction of 2.5 kg, with arthroscopic views of rotator cuff repair (single-row repair using 2 anchors) from laterally. (A) The folded spacer is introduced through the posterior portal and placed in the middle of the subacromial space. The placement is controlled under direct arthroscopic vision. One should note that (B) the folded spacer is placed medially to the suture and (C) the spacer—even when inflated—does not overlap the lateral border of the supraspinatus footprint. (A) Only when the placement is satisfactory is the protecting sleeve pulled back, and (B) the spacer is inflated with the correct amount of irrigation fluid (Table 1). After the handle has been deployed, the arm is moved in (D) abduction and (E) external rotation to ascertain unrestrained mobility. While the arm is moved, the arthroscope checks that there is no spacer dislocation and there is frictionless mobility. Arthroscopy Techniques 2014 3, e605-e609DOI: (10.1016/j.eats.2014.06.017) Copyright © 2014 Arthroscopy Association of North America Terms and Conditions