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Offene transossäre Rekonstruktion der Rotatorenmanschette

Klinische Ergebnisse, Einflussfaktoren und Komplikationen

Open transosseous reconstruction of the rotator cuff

Clinical outcome, influencing factors and complications

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Zusammenfassung

Hintergrund

Die offene transossäre Rotatorenmanschettenrekonstruktion (RMR) nimmt nach wie vor einen hohen Stellenwert in der heutigen Versorgungsrealität ein. Die Ziele dieser Studie waren, mittel- und langfristige klinische Ergebnisse und prognostische Einflussfaktoren zu bestimmen sowie Komplikationen zu analysieren.

Material und Methoden

Die retrospektive Studie schloss 104 Patienten nach standardisierter offener transossärer RMR ein. Nach durchschnittlich 38,3 Monaten (12–71) konnten 88 Patienten (89 Schultergelenke) untersucht werden. Das Durchschnittsalter betrug bei der Operation 57,1 Jahre (29–83). Die standardisierte Nachuntersuchung beinhaltete eine Sonographie und die Erhebung des absoluten, relativen und intraindividuellen Constant-Scores (CSabs, CSrel, CSintra), des Oxford-Shoulder-Scores (OSS), des American-Shoulder-and-Elbow-Surgeons’-Scores (ASESS) und des Single-Assessment-Numeric-Evaluation-Scores (SANES). Das Signifikanzniveau der Varianzanalyse (ANOVA) lag bei p< 0,05 (95%-Konfidenzintervall).

Ergebnisse

Die Mittelwerte und Standardabweichungen (σ) betrugen: CSabs= 71 Punkte (σ: 20,3), CSrel= 76 Punkte (σ: 20,7), CSintra= 86% (σ: 19,5), OSSmod= 77 Punkte (σ: 20,6), ASESS= 73 Punkte (σ: 23,3) und SANES = 72% (σ: 22,0). Die klinischen Ergebnisse fielen günstiger aus, wenn die Beschwerden traumatisch ausgelöst wurden (p< 0,05). Patienten mit Massenrupturen schnitten bei allen Scores schlechter ab (p< 0,05). Selbst nicht versorgungspflichtige Begleitpathologien wirkten sich negativ aus (p< 0,05). Die Faktoren „Operateur“, „Nahtmaterial“ und „Akromioplastik“ nahmen keinen Einfluss auf die Ergebnisse. Revisionsoperationen waren in 12/89 (13,5%) Fällen erforderlich. Die Rerupturrate betrug 19,1%.

Schlussfolgerung

Die objektiven und subjektiven klinischen Ergebnisse nach offener transossärer RMR sind vergleichbar mit zuvor beschriebenen offenen und arthroskopischen Techniken. Ein traumatischer Beschwerdebeginn wirkte sich prognostisch günstig aus. Massenrupturen und selbst nicht versorgungspflichtige Begleitpathologien waren mit schlechteren Ergebnissen assoziiert. Die Durchführung einer offenen oder arthroskopischen Akromioplastik erbrachte keinen zusätzlichen Vorteil. Eine standardisierte Operationstechnik führte unabhängig vom Operateur zu reproduzierbaren Ergebnissen.

Abstract

Background

Open transosseous rotator cuff reconstruction (RCR) still plays a prominent role in current treatment of rotator cuff tears. This study aimed to examine mid-term and long-term results of clinical outcome, determine influencing factors and analyze complications.

Patients

This retrospective cohort study included 104 Patients following standardized open transosseous RCR. After a mean follow-up period of 38.3 months (range 12–71 months) 88 Patients (89 shoulders) were available for examination. The mean age of Patients at surgery was 57.1 years (range 29–83 years). Standardized clinical examination included sonography and assessment of the absolute, relative and intra-individual constant scores (CSabs, CSrel, CSintra), Oxford shoulder score (OSS), American shoulder and elbow surgeons’ score (ASESS) and single assessment numeric evaluation score (SANES). The level of significance for analysis of variance (ANOVA) was set at p< 0.05 (95% confidence interval).

Results

Mean values and standard deviations (σ) were: CSabs= 71 points (σ: 20.3), CSrel= 76 points (σ: 20.7), CSintra= 86 % (σ: 19.5), OSSmod= 77 points (σ: 20.6), ASESS= 73 points (σ: 23.3) and SANES= 72 % (σ: 22.0). Clinical results were superior when the complaints were initiated by trauma (p< 0.05). Patients with massive tears showed inferior results relative to all outcome measures (p< 0.05). Concomitant pathologies even without surgical relevance were associated with inferior outcome (p< 0.05). The factors surgeon, suture material and acromioplasty did not exert a significant influence. Revision surgery was required in 12 out of 89 (13.5 %) cases and re-ruptures occurred in 19.1%.

Conclusions

Objective and subjective clinical results following open transosseous RCR were comparable to those of previously described open and arthroscopic techniques. Results were superior when the complaints were initiated by trauma. Massive tears and concomitant pathologies even without surgical relevance were associated with inferior clinical outcome. Open or arthroscopic acromioplasty did not add further benefits. A standardized operative procedure led to reproducible results irrespective of the factor surgeon.

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Authors and Affiliations

  1. Department Orthopädie und Traumatologie, Klinikum der Albert-Ludwigs Universität Freiburg, Hugstetter Str. 55, 79106, Freiburg, Deutschland

    D. Maier, M. Jaeger, K. Izadpanah, D. Herschel, P.C. Strohm & N.P. Südkamp

  2. Zentrum Sportorthopädie, Freiburg, Deutschland

    P. Ogon

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  1. D. Maier
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Maier, D., Jaeger, M., Izadpanah, K. et al. Offene transossäre Rekonstruktion der Rotatorenmanschette. Chirurg 83, 1068–1077 (2012). https://doi.org/10.1007/s00104-012-2399-2

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