Rice-Body Synovitis, Foreign Body Reaction, and Rotator Cuff Failure After Subacromial Balloon Spacer Augmentation of a Rotator Cuff Repair

Abstract

Case: A 66-year-old woman presented with shoulder pain and weakness 4 months after augmentation of a rotator cuff repair with a Stryker InSpace subacromial balloon spacer. A magnetic resonance imaging (MRI) demonstrated a failed rotator cuff repair, large effusion with rice bodies, synovitis, axillary lymphadenopathy, loose anchors, and erosive changes to the greater tuberosity. Arthroscopy revealed balloon fragmentation surrounded by diffusely hyperemic synovium without repairable cuff tissue. Final cultures proved negative for infection. Histologic evaluation revealed ulcerated synovium with diffuse chronic and focal acute inflammation. Conclusion: Despite promising early results, augmentation of a rotator cuff repair with a subacromial balloon spacer introduces a risk of inflammatory reaction that may mimic a deep infection and compromise rotator cuff healing.