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Operative Orthopädie und Traumatologie

, Volume 24, Issue 6, pp 458–467 | Cite as

Redefekte der Rotatorenmanschette

Ursachen und Therapiestrategien
  • M. ScheibelEmail author
Übersichten

Zusammenfassung

Redefekte der Rotatorenmanschette stellen nach wie vor die Hauptkomplikation nach Rotatorenmanschettenrekonstruktionen dar. Die Genese von Redefekten ist multifaktoriell, wobei überwiegend biologische Faktoren die strukturellen Ergebnisse nach Rotatorenmanschettenrekonstruktion beeinflussen. Grundsätzlich müssen Redefekte, die auf ein Nichteinheilen der rekonstruierten Sehne zurückzuführen sind, von sogenannten echten Rerupturen, die im Verlauf nach primär erfolgreicher osteofibroblastischer Integration auftreten, unterschieden werden. Verschiedene Versagensmechanismen sind hierfür verantwortlich. Das therapeutische Management von Redefekten ist abhängig vom subjektiven Beschwerdebild des Patienten, dem objektiven Funktionszustand und den pathomorphologischen Veränderungen der muskulotendinösen Einheiten und des Schultergelenks. Neben einem „skilfull neglect“ bzw. konservativen Therapiemaßnahmen kommt bei entsprechender Indikation der arthroskopischen Re-Rekonstruktion ein zunehmender Stellenwert hinzu. Irreparable Defektsituationen können je nach Beschwerdebild und Ausdehnung der Ruptur mit einer Muskelersatzlappenplastik (Latissimus-dorsi- oder Pectoralis-major-Transfer) bzw. endoprothetischem Gelenkersatz (inverse Endoprothese) therapiert werden. Insgesamt liegen die Ergebnisse nach Re-Rekonstruktion oder Verwendung von extraanatomischen Muskellappentransfers unter denen nach primärer Sehnenrekonstruktion oder primärem Transfer.

Schlüsselwörter

Rotatorenmanschettenrekonstruktion Redefekte Komplikationen Therapeutisches Management 

Recurrent defects of the rotary cuff

Causes and therapeutic strategies

Abstract

Recurrent defects of the rotator cuff still represent the most common complication after rotator cuff repair. The etiology is multifactorial; however, predominantly biological determinants seem to influence the structural outcome. Basically, recurrent defects due to non-healing of the rotator cuff tendons have to be distinguished from true re-ruptures, which occur after primary successful osteofibroblastic integration. Different modes of failure are responsible for recurrent defects of the rotator cuff. The management of recurrent defects depends on the clinical symptoms of the patient, the objective function of the shoulder and the pathomorphological changes of the rotator cuff and the shoulder joint itself. Beside a skillful neglect and/or conservative management, arthroscopic revision of failed cuff repairs appears to be a promising procedure. Irreparable tears can be managed using extraanatomic tendon transfer (latissimus dorsi or pectoralis major transfer) or shoulder replacement procedures (reverse prosthesis) depending on the functional symptoms of the patient. The results after re-reconstruction or open revision using tendon transfers are inferior compared to primary intervention.

Keywords

Rotator cuff repair Recurrent defects Complications Therapeutic management 

Notes

Interessenkonflikt

Der korrespondierende Autor gibt an, dass kein Interessenkonflikt besteht.

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Copyright information

© Springer-Verlag Berlin Heidelberg 2012

Authors and Affiliations

  1. 1.Centrum für Muskuloskeletale Chirurgie (CMSC), Campus-VirchowCharité-Universitätsmedizin BerlinBerlinDeutschland

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