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Operative Therapie des posterosuperioren Impingements (PSI)

Surgical treatment of posterosuperior impingement (PSI)

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Operative Orthopädie und Traumatologie Aims and scope Submit manuscript

Zusammenfassung

Operationsziel

Wiederherstellung eines physiologischen anterioren und posterioren Kapselvolumens und eines physiologischen Humeruskopfrotationszentrums sowie Behandlung der aufgetretenen Begleitschäden beim posterosuperioren Impingement (PSI).

Indikationen

Sistieren der klinischen Besserung trotz adäquater physiotherapeutischer Behandlung über mindestens 6–12 Monate.

Kontraindikationen

Allgemeine Kontraindikationen für elektiven arthroskopischen Eingriff.

Operationstechnik

Diagnostische Schulterarthroskopie über das posteriore Standardportal mit Stabilitätsprüfung des Labrum-Bizepssehnenanker-Komplexes auch in der „Abduction-and-External-Rotation“(ABER‑)-Position zur Diagnosebestätigung und Identifizierung von Begleitpathologien. Abhängig vom intraoperativen Befund und der klinischen Beschwerdesymptomatik meist Kombinationseingriff aus posterosuperiorer SLAP-Rekonstruktion („superior labrum anterior posterior“) bzw. Tenodese der langen Bizepssehne.

Nachbehandlung

Für insgesamt 6 Wochen Armschlinge mit schrittweiser Freigabe der Beweglichkeit und limitierter 0°-Außenrotation. Freie Beweglichkeit ab der 7., volle Belastbarkeit ab der 12. Woche. Modifikation entsprechend des intraoperativen Befunds und des therapeutischen Vorgehens.

Ergebnisse

In der eigenen Klinik wurde bei 18 Überkopfsportlern (6 Frauen, 12 Männer, durchschnittliches Alter 31 Jahre) mit einem PSI ohne Pathologie des Bizepssehnenankers oder der Rotatorenmanschette eine isolierte anteroinferiore Kapselplikatur nach primär konservativer Therapie durchgeführt. Nach durchschnittlich 9 Monaten erreichten 16 Sportler ihr früheres sportliches Leistungsniveau, 2 mussten aufgrund von persistierenden Schulterbeschwerden die Sportart wechseln. Nach durchschnittlich 27 Monaten (Spanne 12–55 Monate) erreichten Männer im Walch-Duplay-Score durchschnittlich 82,9 ± 8,3, Frauen 73,8 ± 8,3 Punkte.

Abstract

Objective

To restore the physiologic anterior and posterior capsular volume to achieve an anatomic central contact point of the glenohumeral articulation and treatment of concomitant glenohumeral injuries due to posterosuperior impingement (PSI).

Indications

Plateauing of clinical improvement despite adequate nonsurgical treatment (for at least 6–12 months).

Contraindications

General contraindications for elective arthroscopic surgery.

Surgical technique

Diagnostic arthroscopy of the glenohumeral joint through the posterior portal to assess stability of the biceps–labral complex even in the Abduction and External Rotation (ABER) position to confirm the diagnosis of PSI and to detect concomitant glenohumeral injuries. In most cases posterosuperior SLAP (superior labrum anterior posterior) repair or tenodesis of the long head of the biceps.

Postoperative management

Arm sling for 6 weeks with limited range of motion. Free active range of motion of elbow and wrist. Limited shoulder external rotation for 6 weeks. Free shoulder range of motion from week 7, full daily life activities after 12 weeks. Modification of the postoperative management according to intraoperative findings.

Results

At our hospital 18 overhead athletes (6 women, 12 men, mean age 31 years) with PSI without SLAP lesion or rotator cuff tear underwent isolated plication of the anteroinferior capsule after primary nonsurgical treatment. At a mean period of 9 months, 16 patients returned to their pre-injury sports activity level, 2 patients had to give up their sports due to persisting shoulder problems. At a mean follow-up of 27 months (range 12–55 months) the Walch Duplay score was on average 82.9 ± 8.3 for men and 73.8 ± 5.9 for women.

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Authors and Affiliations

  1. Abteilung für Sportorthopädie, Klinikum rechts der Isar, Technische Universität München, Ismaningerstraße 22, 81675, München, Deutschland

    M. Beirer, G. H. Sandmann,  A. B. Imhoff & S. Buchmann

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  1. M. Beirer
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  2. G. H. Sandmann
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  3. A. B. Imhoff
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  4. S. Buchmann
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Corresponding author

Correspondence to A. B. Imhoff.

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Interessenkonflikt

M. Beirer und G. H. Sandmann geben an, dass kein Interessenkonflikt besteht. S. Buchmann und A. B. Imhoff sind Berater der Firma Arthrex GmbH.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

Additional information

Redaktion

A.B. Imhoff, München

Zeichner

R. Himmelhan, Mannheim

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Beirer, M., Sandmann, G.H., Imhoff, A.B. et al. Operative Therapie des posterosuperioren Impingements (PSI). Oper Orthop Traumatol 28, 430–437 (2016). https://doi.org/10.1007/s00064-016-0465-5

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  • DOI: https://doi.org/10.1007/s00064-016-0465-5

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