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Z Orthop Unfall 2009; 147(3): 321-326
DOI: 10.1055/s-2008-1039224
OP-Techniken

© Georg Thieme Verlag KG Stuttgart · New York

Operative Therapie und Nachbehandlung der Rotatorenmanschettenruptur – Aktueller Stand

Operative and Follow-Up Treatment of Rotator Cuff Tears – The Current SituationM. D. Schofer1 , M. Quante1 , C.-D. Peterlein1 , N. Timmesfeld2 , K. Phan1 , S. Fuchs-Winkelmann1
  • 1Orthopädie und Rheumatologie, Universitätsklinikum Marburg
  • 2Institut für Medizinische Biometrie und Epidemiologie, Universitätsklinikum Marburg
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Publication History

Publication Date:
23 June 2009 (online)

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Zusammenfassung

Studienziel: Ziel der Untersuchung war die Erhebung des aktuellen Standes der Rotatorenmanschetten(RM)-Refixation und Nachbehandlung in den deutschen Krankenhäusern. Methoden: Ein zuvor evaluierter Fragebogen wurde an alle 777 orthopädischen und/oder unfallchirurgischen Krankenhausabteilungen in Deutschland verschickt. Die Auswahl der Krankenhäuser erfolgte anhand der amtlichen Krankenhausstatistik des Statistischen Bundesamts. Es wurde das Jahr 2006 abgefragt. Ergebnisse: Die Rückläuferquote lag bei 44 %, wobei 40 % der Fragebögen auswertbar waren. Es wurden in den 309 Abteilungen 59 957 Schulteroperationen mit einem Anteil von 26 % RM-Refixationen erhoben. Die Operationstechnik war bei 49 % mini-offen, bei 29 % offen und bei 22 % arthroskopisch. Hierbei ergaben sich Unterschiede zwischen den Fachabteilungen und der Versorgungsstufe. In 52 % der Abteilungen wurde keine arthroskopische RM-Refixation durchgeführt, während in 48 % der Abteilungen die RM-Refixation in offener als auch in arthroskopischer Technik erfolgte. Die arthroskopische Operationstechnik wurde in spezialisierten Schulterabteilungen häufiger eingesetzt. Eine standardisierte oder durch einen Behandlungspfad festgelegte Nachbehandlung erfolgte in 79 % der Abteilungen. Schlussfolgerung: Die RM-Refixation erfolgt am häufigsten in offener Technik, wobei die mini-offene Technik als heutiger Goldstandard bezeichnet werden kann.

Abstract

Aim: The aim of this study was to evaluate the current situation of rotator cuff repair and follow-up treatment in German hospitals. Methods: An evaluated survey, enquiring about the year 2006, was sent to all 777 German orthopaedic and/or trauma surgery departments. The hospitals were chosen using the official index of hospitals from the German Federal Statistical Office. Results: 44 % of the surveys were sent back, whereby 40 % were of use. Within the 309 departments, 26 % of the total number of 59,957 shoulder operations were rotator cuff repairs. Mini-open was the operation method in 49 %, open in 29 % and arthroscopic in 22 % of cases. Regarding the operational methods, there were differences between the departments and level of care. The arthroscopic technique was used sometimes in 48 % of the departments, whereas 52 % never used it. Specialised shoulder departments employed the total arthroscopic procedure more often. A set follow-up treatment occurred in 79 % of departments. Conclusion: Rotator cuff repair is mainly carried out using the mini-open method, which is nowadays regarded as gold standard.

Schlüsselwörter

Schulter - RotatorenmanschettenRefixation - Rotatorenmanschetten - Nachbehandlung - Fragebogen

Key words

shoulder - rotator cuff - rotator cuff repair - rehabilitation - questionnaire

Literatur

  • 1 Ozbaydar M, Chung S, Diller D, Warner J J. Die arthroskopische Rekonstruktion der Rotatorenmanschette.  Orthopäde. 2007;  36 825-833
    CrossrefPubMedGoogle Scholar
  • 2 Sher J S, Uribe J W, Posada A, Murphy B J, Zlatkin M B. Abnormal findings on magnetic resonance images of asymptomatic shoulders.  J Bone Joint Surg Am. 1995;  77 10-15
    PubMedGoogle Scholar
  • 3 Milgrom C, Schaffler M, Gilbert S, van Holsbeeck M. Rotator-cuff changes in asymptomatic adults. The effect of age, hand dominance and gender.  J Bone Joint Surg Br. 1995;  77 296-298
    PubMedGoogle Scholar
  • 4 Codman E A. Complete rupture of the supraspinatus tendon. Operative treatment with report of two successful cases.  Boston Medical and Surgical Journal. 1911;  20 708-710
    PubMedGoogle Scholar
  • 5 Codman E A. Rupture of the supraspinatus tendon. 1911.  Clin Orthop Relat Res. 1990;  254 3-26
    PubMedGoogle Scholar
  • 6 Levy H J, Uribe J W, Delaney L G. Arthroscopic assisted rotator cuff repair: preliminary results.  Arthroscopy. 1990;  6 55-60
    PubMedGoogle Scholar
  • 7 Bishop J, Klepps S, Lo I K, Bird J, Gladstone J N, Flatow E L. Cuff integrity after arthroscopic versus open rotator cuff repair: a prospective study.  J Shoulder Elbow Surg. 2006;  15 290-299
    CrossrefPubMedGoogle Scholar
  • 8 Buess E, Steuber K U, Waibl B. Open versus arthroscopic rotator cuff repair: a comparative view of 96 cases.  Arthroscopy. 2005;  21 597-604
    PubMedGoogle Scholar
  • 9 Kang L, Henn R F, Tashjian R Z, Green A. Early outcome of arthroscopic rotator cuff repair: a matched comparison with mini-open rotator cuff repair.  Arthroscopy. 2007;  23 573-582, 582 e1–2
    PubMedGoogle Scholar
  • 10 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
    PubMedGoogle Scholar
  • 11 Liem D, Bartl C, Lichtenberg S, Magosch P, Habermeyer P. Clinical outcome and tendon integrity of arthroscopic versus mini-open supraspinatus tendon repair: a magnetic resonance imaging-controlled matched-pair analysis.  Arthroscopy. 2007;  23 514-521
    PubMedGoogle Scholar
  • 12 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
    PubMedGoogle Scholar
  • 13 Tauro J C. Arthroscopic rotator cuff repair: analysis of technique and results at 2- and 3-year follow-up.  Arthroscopy. 1998;  14 45-51
    PubMedGoogle Scholar
  • 14 Pearsall 4th A, Ibrahim K A, Madanagopal S G. The results of arthroscopic versus mini-open repair for rotator cuff tears at mid-term follow-up.  J Orthop Surg. 2007;  2 24
    CrossrefPubMedGoogle Scholar
  • 15 Millett P J, Wilcox 3rd R B. Rehabilitation of the rotator cuff: an evaluation-based approach.  J Am Acad Orthop Surg. 2006;  14 599-609
    PubMedGoogle Scholar
  • 16 Chong M, Karataglis D, Learmonth D. Survey of the management of acute traumatic first-time anterior shoulder dislocation among trauma clinicians in the UK.  Ann R Coll Surg Engl. 2006;  88 454-458
    CrossrefPubMedGoogle Scholar
  • 17 Lüring C, Diedrich O, Köck F X, Grifka J, Tingart M. Aktuelle operative Therapiestrategien der Rotatorenmanschettenruptur an deutschen Kliniken.  Orthopäde. 2007;  36 810-816
    CrossrefPubMedGoogle Scholar
  • 18 Dunn W R, Schackman B R, Walsh C, Lyman S, Jones E C, Warren R F, Marx R G. Variation in orthopaedic surgeons' perceptions about the indications for rotator cuff surgery.  J Bone Joint Surg Am. 2005;  87 1978-1984
    CrossrefPubMedGoogle Scholar
  • 19 Iannotti J P, Ciccone J, Buss D D, Visotsky J L, Mascha E, Cotman K, Rawool N M. Accuracy of office-based ultrasonography of the shoulder for the diagnosis of rotator cuff tears.  J Bone Joint Surg Am. 2005;  87 1305-1311
    CrossrefPubMedGoogle Scholar
  • 20 Gohlke F, Rolf O, Böhm D. Offene Rekonstruktion der Rotatorenmanschette.  Orthopäde. 2007;  36 834-847
    CrossrefPubMedGoogle Scholar
  • 21 Hedtmann A, Heers G. Bildgebende Verfahren bei Rotatorenmanschettendefekten der Schulter.  Orthopäde. 2007;  36 796-809
    CrossrefPubMedGoogle Scholar
  • 22 Read J W, Perko M. Shoulder ultrasound: diagnostic accuracy for impingement syndrome, rotator cuff tear, and biceps tendon pathology.  J Shoulder Elbow Surg. 1998;  7 264-271
    CrossrefPubMedGoogle Scholar
  • 23 Wiener S N, Seitz Jr W H. Sonography of the shoulder in patients with tears of the rotator cuff: accuracy and value for selecting surgical options.  AJR Am J Roentgenol. 1993;  160 103-107; discussion 109–110
    PubMedGoogle Scholar
  • 24 Ejnisman B, Andreoli C V, Soares B G, Fallopa F, Peccin M S, Abdalla R J, Cohen M. Interventions for tears of the rotator cuff in adults.  Cochrane Database Syst Rev. 2004;  CD002758
    PubMedGoogle Scholar
  • 25 Guttmann D, Graham R D, MacLennan M J, Lubowitz J H. Arthroscopic rotator cuff repair: the learning curve.  Arthroscopy. 2005;  21 394-400
    PubMedGoogle Scholar
  • 26 Brucker P U, Jost B. Biologische und biomechanische Grundlagen der arthroskopischen Rotatorenmanschettenrekonstruktion.  Arthroskopie. 2007;  20 13-21
    CrossrefPubMedGoogle Scholar
  • 27 Pietschmann M F, Fröhlich V, Ficklscherer A, Hausdorf J, Utzschneider S, Jansson V, Müller P E. Pullout strength of suture anchors in comparison with transosseous sutures for rotator cuff repair.  Knee Surg Sports Traumatol Arthrosc. 2008;  16 504-510
    CrossrefPubMedGoogle Scholar
  • 28 Chhabra A, Goradia V K, Francke E I, Baer G S, Monahan T, Kline A J, Miller M D. In vitro analysis of rotator cuff repairs: a comparison of arthroscopically inserted tacks or anchors with open transosseous repairs.  Arthroscopy. 2005;  21 323-327
    PubMedGoogle Scholar
  • 29 Goradia V K, Mullen D J, Boucher H R, Parks B G, O'Donnell J B. Cyclic loading of rotator cuff repairs: A comparison of bioabsorbable tacks with metal suture anchors and transosseous sutures.  Arthroscopy. 2001;  17 360-364
    PubMedGoogle Scholar
  • 30 Barber F A, Herbert M A, Coons D A, Boothby M H. Sutures and suture anchors – update 2006.  Arthroscopy. 2006;  22 1063-e1–9
    CrossrefPubMedGoogle Scholar
  • 31 Wust D M, Meyer D C, Favre P, Gerber C. Mechanical and handling properties of braided polyblend polyethylene sutures in comparison to braided polyester and monofilament polydioxanone sutures.  Arthroscopy. 2006;  22 1146-1153
    PubMedGoogle Scholar
  • 32 Neer 2nd C S. Impingement lesions.  Clin Orthop Relat Res. 1983;  173 70-77
    PubMedGoogle Scholar
  • 33 Löhr J F, Uhthoff H K. Epidemiologie und Pathophysiologie der Rotatorenmanschettenrupturen.  Orthopäde. 2007;  36 788-795
    CrossrefPubMedGoogle Scholar
  • 34 McCallister W V, Parsons I M, Titelman R M, Matsen 3rd F A. Open rotator cuff repair without acromioplasty.  J Bone Joint Surg Am. 2005;  87 1278-1283
    CrossrefPubMedGoogle Scholar
  • 35 Milano G, Grasso A, Salvatore M, Zarelli D, Deriu L, Fabbriciani C. Arthroscopic rotator cuff repair with and without subacromial decompression: a prospective randomized study.  Arthroscopy. 2007;  23 81-88
    PubMedGoogle Scholar
  • 36 Gartsman G M, O'Connor D P. Arthroscopic rotator cuff repair with and without arthroscopic subacromial decompression: a prospective, randomized study of one-year outcomes.  J Shoulder Elbow Surg. 2004;  13 424-426
    CrossrefPubMedGoogle Scholar
  • 37 Beall D P, Williamson E E, Ly J Q, Adkins M C, Emery R L, Jones T P, Rowland C M. Association of biceps tendon tears with rotator cuff abnormalities: degree of correlation with tears of the anterior and superior portions of the rotator cuff.  AJR Am J Roentgenol. 2003;  180 633-639
    CrossrefPubMedGoogle Scholar
  • 38 Szabo I, Boileau P, Walch G. The proximal biceps as a pain generator and results of tenotomy.  Sports Med Arthrosc. 2008;  16 180-186
    CrossrefPubMedGoogle Scholar

Dr. Markus Schofer

Orthopädie und Rheumatologie
Universitätsklinikum Marburg

Baldingerstraße

35033 Marburg

Phone: 0 64 21/2 86 49 20

Fax: 0 64 21/2 86 70 07

Email: schofer@med.uni-marburg.de

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