Therapieoptionen bei primär nichtrekonstruierbaren Rotatorenmanschetten-Läsionen

J. Kircher; A. Hedtmann; A. Niemeier

doi:10.1055/s-0037-1617747

Arthritis und Rheuma, Inhaltsverzeichnis

Arthritis und Rheuma 2016; 36(05): 325-329
DOI: 10.1055/s-0037-1617747

Schulterschmerz

Schattauer GmbH

Therapieoptionen bei primär nichtrekonstruierbaren Rotatorenmanschetten-Läsionen

Therapeutic options for primary non-reconstructable rotator cuff lesions

J. Kircher

¹Klinik Fleetinsel Hamburg, Schulter- und Ellenbogenchirurgie, Hamburg

³Orthopädische Klinik, Universitätsklinikum, Medizinische Fakultät, Heinrich-Heine-Universität Düsseldorf, Düsseldorf

,

A. Hedtmann

¹Klinik Fleetinsel Hamburg, Schulter- und Ellenbogenchirurgie, Hamburg

,

A. Niemeier

²Klinik und Poliklinik für Orthopädie, Universitätsklinikum Hamburg-Eppendorf, Hamburg

› Institutsangaben

Abstract

Zusammenfassung

Rotatorenmanschetten-Läsionen sind häufige Erkrankungen mit einer altersabhängigen Zunahme in den entwickelten Ländern. Frühstadien und Partialläsionen zeigen sehr gute Langzeitresultate nach operativer Therapie. Verspätet erkannte Läsionen oder Re-Rupturen nach operativer Therapie sind oft nicht mehr rekonstruierbar und durch einen zentralen Sehnendefekt gekennzeichnet. Durch das oft höhere Lebensalter der Patienten in Kombination mit gestiegenen Ansprüchen stellt diese Patientenklientel eine besondere therapeutische Herausforderung dar. Sobald die Schulter einmal funktionell dekompensiert ist, bestehen kaum Chancen, durch konservative Therapie noch eine relevante Verbesserung zu erzielen. Es existieren daher verschiedene operative Ansätze, die Defekte funktionell zu kompensieren: die partielle Defektrekonstruktion unter Belassen partieller Defekte mit oder ohne Patch-Augmenta tion der Naht; Muskel-Sehnen-Schwenk- Operationen (Latissimus dorsi, Pectoralis major), der Einsatz von Defekt-überbrückenden Implantaten (künstliches oder allogenes Sehnenersatzmaterial), der Einsatz von Platzhaltern (subakromialer Ballon) bis hin zum endoprothetischen Schultergelenkersatz mittels inverser Endoprothese. Zuletzt wurde die Methode der sogenannten Superior Capsule Reconstruction popularisiert. Trotz einiger Fortschritte in vielen dieser Techniken sind die funktionellen Ergebnisse bei konservativer und operativer Therapie von primär nicht rekonstruierbaren Rupturen weiterhin der erfolgreichen Manschettenrekonstruktion unterlegen.

Summary

Rotator cuff lesions are a common disease with an age-dependent increase in the developed countries. Early stages of the disease and partial tears show excellent results after operative therapy. Advanced stages after delayed diagnosis and recurrence after surgical repair are characterized by a central tendon defect which often is not amenable to reconstruction. This patient group is a challenge to modern shoulder surgery due to the increasing life expectancy in combination with functional demands. Once functional decompensation is present the chances for relevant clinical improvement by conservative treatment are small. Several treatment options exist to achieve functional compensation: partial reconstruction with acceptance of small defects with or without patch augmentation; muscle tendon transfers (Latissimus dorsi, Pectoralis major); implantation of defect bridging materials (autologous or allogenic tendon replacement); implantation of spacers (subacromial balloon) and joint replacement by a reverse shoulder arthroplasty. Recently the method of superior capsule repair became popular. Despite a considerable progress in many of these techniques the functional results of operative and conservative therapy of primary non-reconstructable lesions are less favourable in comparison to a successful rotator cuff repair.

Schlüsselwörter

Schulter - Chirurgie - Sehne - autolog - Rotatorenmanschette - Patch-Augmentation - Transplantation

Keywords

Shoulder - surgery - tendon - autologous - rotator cuff - patch - transplantation

Volltext

Referenzen

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