Zusammenfassung
Die operative Rekonstruktion der Rotatorenmanschette hat zum Ziel, die volle Funktion
des Schultergelenks durch Wiederherstellung eines stabilen Drehzentrums zu gewährleisten.
Die offene operative Technik steht der neueren arthroskopischen Methode gegenüber.
Die Frage, ob die arthroskopische Technik der offenen Nahttechnik überlegen ist, gilt
es nach derzeitigem Wissensstand zu klären.
In rezenten Arbeiten (s. Literaturliste) sind die Nachuntersuchungszeiträume hinsichtlich
der arthroskopischen Rotatorenmanschettennähte wesentlich kürzer (3 Jahre) als bei
der offenen Nahttechnik, wo schon längerfristige Studien (im Mittel 6,2 Jahre) vorliegen.
In einer Literaturzusammenstellung wird gezeigt, dass bei der arthroskopischen Technik
gute bis sehr gute Ergebnisse in 68 und 96 % angegeben werden. Bei der offenen Nahttechnik
werden gute bis sehr gute Ergebnisse zwischen 77 und 91 % angegeben. Die Haltbarkeit
der Sehnennähte erscheint bei den arthroskopischen Nähten, vor allem, wenn es sich
um große Risse handelt, deutlich kürzer zu sein als bei der offenen Technik. Mehrere
Autoren geben unabhängig voneinander an, dass die Haltbarkeit der Sehnennähte mit
Größe des Defektes zunimmt. Dem steht gegenüber, dass auch bei Rerupturen, speziell
bei der arthroskopischen Nahttechnik, eine hohe Anzahl an sehr guten klinischen Ergebnissen
zu erzielen war.
Bei Einsehnenrissen dürfte die arthroskopische Nahttechnik der offenen Nahttechnik
überlegen sein. Bei Zwei- und Dreisehnenrissen ist nach wie vor die offene Nahttechnik
nach Durchsicht der Literatur der Goldstandard. Für die Zukunft sind langfristige
Untersuchungen vonnöten, um die beiden Nahttechniken wirklich vergleichbar zu machen,
wobei Faktoren wie Rissgröße, Alter auf der einen Seite und Patientenzufriedenheit
sowie Lebensqualität andererseits neben schulterspezifischen Scores die Parameter
der Untersuchung sein sollten.
Summary
Reconstructive surgery of rotator cuff tears tries to restore a stable center of rotation
in the shoulder joint. Both the classic technique of open surgery and the arthroscopic
technique are employed to reconstruct the rotator cuff. This review tries to answer
the question which of both surgical techniques is superior by a review of the literature.
The recent literature demonstrates a shorter follow-up period for publications concerning
arthroscopic reconstruction (mean 3 years) in comparison to open surgery, where follow-up
is in mean 6.2 years. Overall arthroscopic surgery achieves good and excellent results
between 68 to 96 %, open reconstruction between 77 and 91 %. Longevity of reconstructed
rotator cuffs especially in large tears seems to be significantly shorter if an arthroscopic
technique was used. Several authors mentioned size of tear as a major factor influencing
longevity. However in patients treated arthroscopically despite rerupture of the rotor
cuff patient's satisfaction and clinical outcome is still very good in short-term
follow-up.
In case of a complete tear of one tendon of the rotator cuff the arthroscopic technique
seems to be superior. If large tears occur (two or three tendons) the open surgical
technique may be more reliable with regard to longevity of the repair. For the future
it seems necessary to obtain long-term results to be able to compare both principles
of reconstruction of the rotator cuff. Furthermore these future studies should include
quality of life scores as measurements tools besides the already employed parameters
as size of the tear, age at surgery, patient satisfaction and outcome scores.
Literatur
- 1
Zvijac J E, Levy H J, Lemak L J.
Arthroscopic subacromial decompression in the treatment of full thickness rotator
cuff tears: a 3- to 6-year follow-up.
Arthroscopy.
1994;
10
518-523
- 2
Kempf J F, Gleyze P, Bonnomet F. et al .
A multicenter study of 210 rotator cuff tears treated by arthroscopic acromioplasty.
Arthroscopy.
1999;
15
56-66
- 3
Ellman H, Kay S P.
Arthroscopic subacromial decompression for chronic impingement: two to five year results.
J Bone Joint Surg Br.
1991;
73
395-398
- 4
Gartsman G M, Brinker M R, Khan M.
Early effectiveness of arthroscopic repair for full-thickness tears of the rotator
cuff: an outcome analysis.
J Bone Joint Surg Am.
1998;
80
33-40
- 5
Gartsman G M, Khan M, Hammerman S M.
Arthroscopic repair of full-thickness tears of the rotator cuff.
J Bone Joint Surg Am.
1998;
80
832-840
- 6
Burkhart S S.
Arthroscopic treatment of massive rotator cuff tears.
Clin Orthop.
2001;
390
107-118
- 7
Hoffmann F, Schiller M, Reif G.
Arthroskopische Rotatorenmanschettenrekonstruktion.
Orthopäde.
2000;
29
888-894
- 8
Lo I K, Burkhart S S.
Transtendon arthroscopic repair of partial-thickness, articular surface tears of the
rotator cuff.
Arthroscopy.
2004;
20
214-220
- 9
Gartsman G M.
Arthroscopic treatment of rotator cuff disease.
J Shoulder Elbow Surg.
1995;
4
228-241
- 10
Wright S A, Cofield R H.
Management of partial-thickness rotator cuff tears.
J Shoulder Elbow Surg.
1996;
5
458-466
- 11 Nottage W M. Arthroscopic treatment of partial thickness rotator cuff tears. Presented
at the 19 th Annual San Diego Shoulder Course, La Jolla, CA. 2002
- 12
Schneeberger A G, von Roll A, Kalberer F, Jacob H A, Gerber C.
Mechanical strength of arthroscopic rotator cuff repair techniques: an in vitro study.
J Bone Joint Surg Am.
2002;
84
2152-2160
- 13
Gerber C, Schneeberger A G, Perren S M, Nyffeler R W.
Experimental rotator cuff repair. A preliminary study.
J Bone Joint Surg Am.
1999;
81
1281-1290
- 14
Gerber C, Schneeberger A G, Beck M, Schlegel U.
Mechanical strength of repairs of the rotator cuff.
J Bone Joint Surg Br.
1994;
76
371-380
- 15
Barber F A, Herbert M A, Richards D P.
Sutures and suture anchors: Update 2003.
Arthroscopy.
2003;
19
985-990
- 16
Wolf E M, Pennington W T, Agrawal V.
Arthroscopic rotator cuff repair: 4- to 10-year results.
Arthroscopy.
2004;
20
5-12
- 17
Burkhart S S, Danaceau S M, Pearce Jr C E.
Arthroscopic rotator cuff repair: analysis of results by tear size and by repair technique-margin
convergence versus direct tendon-to-bone repair.
Arthroscopy.
2001;
17
905-912
- 18
Kim S H, Ha K I, Park J H, Kang J S, Oh S K, Oh I.
Arthroscopic versus mini-open salvage repair of the rotator cuff tear: outcome analysis
at 2 to 6 years' follow-up.
Arthroscopy.
2003;
19
746-754
- 19
Park J Y, Chung K T, Yoo M J.
A serial comparison of arthroscopic repairs for partial- and full-thickness rotator
cuff tears.
Arthroscopy.
2004;
20
705-711
- 20
Jones C K, Savoie 3rd F H.
Arthroscopic repair of large and massive rotator cuff tears.
Arthroscopy.
2003;
19
564-571
- 21
Galatz L M, Ball C M, Teefey S A, Middleton W D, Yamaguchi K.
The outcome and repair integrity of completely arthroscopically repaired large and
massive rotator cuff tears.
J Bone Joint Surg Am.
2004;
86
219-224
- 22
Boszotta H, Prunner K.
Arthroscopically assisted rotator cuff repair.
Arthroscopy.
2004;
20
620-626
- 23 Anderl W. Persönliche Kommunikation. KH Barmherzige Schwestern, Wien.
- 24
Weber S C, Sager R.
All arthroscopic versus mini open repair in the management of tears of the rotator
cuff. 68th Meeting Proceedings.
Am Acad Orthop Surg.
2001;
2
617
- 25
Neer C S. et al .
Tears of the rotator cuff. Long term result of anterior acromioplasty and repair.
Orthop Trans.
1988;
12
735
- 26
Cofield R H, Parvizi J, Hoffmeyer P J, Lanzer W L, Ilstrup D M, Rowland C M.
Surgical repair of chronic rotator cuff tears. A prospective long-term study.
J Bone Joint Surg Am.
2001;
83
71-77
- 27
Pfahler M, Branner S, Refior H J.
Complete rotator cuff rupture-differential surgical techniques and intermediate-term
results.
Z Orthop Ihre Grenzgeb.
1999;
137
295-300
- 28
Bezer M, Kocaoglu B, Erol B, Aydin N, Guven O.
Long-term results of open surgical repair of rotator cuff tears.
Acta Orthop Traumatol Turc.
2004;
38
110-114
- 29
Hawkins R J, Misamore G W, Hobeika P E.
Surgery for full-thickness rotator-cuff tears.
J Bone Joint Surg Am.
1985;
67
1349-1355
- 30
Motycka T, Kriegleder B, Landsiedl F.
Results of open repair of the rotator cuff-a long-term review of 79 shoulders.
Arch Orthop Trauma Surg.
2001;
121
148-151
- 31
Cofield R H, Parvizi J, Hoffmeyer P J, Lanzer W L, Ilstrup D M, Rowland C M.
Surgical repair of chronic rotator cuff tears. A prospective long-term study.
J Bone Joint Surg Am.
2001;
83
71-77
- 32
Böhm T D, Ilg A, Werner A, Kirschner S, Gohlke F.
Long-term results (5 - 13 years) after surgical local repair and deltoid muscle flap
for massive rotator cuff tears.
Z Orthop.
2004;
142
228-234
- 33
Gazielly D F, Gleyze P, Montagnon C. et al .
Functional and anatomical results after surgical treatment of ruptures of the rotator
cuff. I. Preoperative functional and anatomical evaluation of ruptures of the rotator
cuff.
Rev Chir Orthop Reparatrice Appar Mot.
1995;
81
8-16
- 34
Wulker N, Melzer C, Wirth C J.
Shoulder surgery for rotator cuff tears. Ultrasonographic 3 year follow-up of 97 cases.
Acta Orthop Scand.
1991;
62
142-147
- 35
Severud E L, Ruotolo C, Abbott D D, Nottage W M.
All-arthroscopic versus mini-open rotator cuff repair: a long-term retrospective outcome
comparison.
Arthroscopy.
2003;
19
234-238
- 36
Baker C L, Liu S H.
Comparison of open and arthroscopic assisted rotator cuff repairs.
Am J Sports Med.
1995;
23
99-104
- 37
Kim S H, Ha K I, Park J H, Kang J S, Oh S K, Oh I.
Arthroscopic versus mini-open salvage repair of the rotator cuff tear: outcome analysis
at 2 to 6 years' follow-up.
Arthroscopy.
2003;
19
746-754
Dr. Christian Wurnig
Orthopädisches Spital Wien-Speising
Abteilung Orthopädie II
Speisinger Straße 109
1130 Wien
Austria
eMail: christian.wurnig@oss.at
