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The InSpace (Orthospace) Biodegradable Balloon System is also known as the Subacromial Balloon Spacer. These spacers are composed of polylactide and ε-caprolactone copolymer.  Spacers are biodegradable and are believed to last 12 months or less.  The placement of these spacers is usually Minimally invasive with a low complication rate. 
Subacromial balloon spacers are used for massive rotator cuff tears. Other typical interventions for large rotator cuff tears are partial tendon repair, subacromial decompression, biceps tenodesis, and reverse total shoulder arthroplasty.  There is currently no gold standard of care. This The choice of treatment depends on several factors, including the patient’s age, medical history, and shoulder condition.
Surgical procedures for subacromial balloon spacers are usually performed arthroscopically through the lateral shoulder.  This device improves shoulder biomechanics when the rotator cuff is beyond repair.  It reduces subacromial friction, bringing the humeral head closer together Against the glenoid. 
Subacromial balloon spacers are useful for large rotator cuff tears or tears that cannot be repaired. Massive rotator cuff tears were considered tears ≥ 5 cm or involving 2 or more tendons.  Unrepairable tears include tears that cannot be repaired to a natural footprint, or if repaired it would Tears Common signs of an irreparable tear include fatty infiltration of 50% or more of the humeral head with static elevation and loss of the scapulohumeral space.  Subacromial balloon spacers may also be used in younger patients to allow more time before more radical surgery The procedure is performed like a shoulder replacement. 
Appropriate patient selection is important when considering the use of a subacromial balloon spacer. Patients with glenohumeral arthritis with irreparable subscapularis tears as well as patients with infections and allergies to device materials. 
The function of the subacromial airbag spacer is to restore the normal biomechanics of the shoulder. The shim depresses the humeral head so that it sits more centrally in the glenoid.  This restores the coupling between the subscapularis and teres minor and improves The function of the deltoid muscle.  This improves abduction and pain relief by reducing impingement. Balloon Spacers also reduce friction, redistribute forces and promote smooth glide of the humeral head. 
After surgery, the spacers will remain inflated for 6-12 months.  This retrains the muscles around the shoulder joint to improve muscle balance and biomechanics. 
The complication rate ranged from 2-16.7%.  The most common complication is shim displacement.  The next surgical intervention was reverse total shoulder arthroplasty. 
MRI and X-rays are often used to determine the diagnosis and extent of shoulder injuries. This will lead to the identification of patient-appropriate interventions.
Patients typically receive a variety of conservative treatments before discussing surgical intervention. Patients typically receive treatment from a physical therapist to improve ROM stability and strength of the shoulder joint. Patients may also receive injections and other treatments. Once these If the intervention fails, the patient will receive a surgical consultation to discuss the best course of action for that patient.
There are currently no clear criteria for a rehabilitation protocol to optimize postoperative subacromial balloon spacer management. Physiotherapists should always discuss surgical precautions with the referring physician. A typical surgical protocol involves wearing a sling for 4-6 weeks.
Precautions after surgery typically include: Immobilization for 4-6 weeks; No sudden movements for 3 months No repetitive movements or heavy lifting. 
A general protocol is provided below. Always check with your referring surgeon on the specifics of each patient.
Phase I (Day 0-4 weeks):
- Use of immobilizing sling
- Modalities as needed
- PROM A/AROM exercises to stay within the pain threshold. Shoulder should be limited to 0-600 
- Pendulum exercises
Phase II (4-6 weeks):
- Use less straps (for comfort only). 
- PROM/AROM for full motion. 
- Driving can resume once the patient can safely keep their hands on the steering wheel and is not using prescription pain medications that could impair their ability to drive. 
Phase III (6-12 weeks):
- Temporary discomfort is normal during this phase. 
- Continue to advance the ROM and include enhancements. 
- Start to return to normal activity.
Phase IV (12+ weeks)
- Recovery may continue up to 6 months after surgery. 
- Stewart RK, Kaplin L, Parada SA, Graves BR, Verma NN, Waterman BR. Outcomes of subacromial balloon spacer implantation for massive and irreparable rotator cuff tears. Orthop. J. Sports Med.7(10), 2325967119875717. DOI: 10.1177/2325967119875717. 1-10.
- Knapik DM, Williams BT, Verma NN. Balloon spacers in the management of massive rotator cuff tears: a focus on clinical outcomes. Ann Joint. 2021;6:19. dx.doi.org/10.21037/aoj-20-35. 1-10.
- Shoulder Balloon Implant Protocol. OrthoIllinois Rehabilitation, 2021.
- Post-Operative Protocol for Patients Following InSpace Implantation. Ortho Space. 2022.