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Sensomotorik nach Kapsellabrumrekonstruktion bei chronischer Schulterinstabilität

Eine klinisch-experimentelle Studie

Sensorimotor deficit after capsulolabral reconstruction in chronic instability of the shoulder

A clinical experimental study

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Zusammenfassung

Die vordere Kapsellabrumrekonstruktion nach JOBE ist eine Modifikation der Bankart-Operation, wobei der Kapselshift durch eine quere Kapselinzision über einen Subscapularissplit-Zugang ohne Durchtrennung der Muskulatur erfolgt. Insgesamt wurden 43 Patienten aufgrund einer posttraumatischen, chronischen, vorderen Schulterinstabilität operiert. Nach durchschnittlich 3,7±1,4 Jahren wurden 35 Patienten nachuntersucht. 29 Patienten (82,9%) waren schmerzfrei, die Funktionsprüfung zeigte ein mittleres Außenrotationsdefizit von 4,1°±2,9° ohne sonstige Bewegungseinschränkungen.

Im Constant-Murley-Score wurden durchschnittlich 92,4±7,1 Punkte und im ASES-Score 93,3±8,4 Punkte erreicht. Die Reluxationsrate betrug 7,7%. Analog zur relevanten Literatur wurde auch in dieser Studie aufgezeigt, dass trotz der guten klinischen Ergebnisse lediglich 69% der Patienten ihr ursprüngliches sportliches Leistungsniveau erreichten. Diese Problematik wurde durch die Bestimmung der Propriozeption und der elektromyographischen Muskelaktivitäten adressiert, wobei postoperativ im Gegensatz zu den vorliegenden Studien ein verbleibendes Propriozeptionsdefizit sowie ein verändertes EMG-Muster mit einer signifikanten Aktivitätsminderung des M. deltoideus auf der operierten Seite nachgewiesen wurde.

Abstract

The anterior capsulolabral reconstruction technique described by Jobe is a modified Bankart repair. The capsular shift is performed in a horizontal direction via a subscapularis split approach avoiding any incision of the muscle.

Of 43 patients with posttraumatic anterior shoulder instability treated by anterior capsulolabral reconstruction, 35 were examined after 3.7±1.4 years, and of these, 29 (82.9%) had no pain; the external rotation deficit was 4.1±2.9°.

The average Constant-Murley score was 92.4±7.1 and the average ASES score was 93.3±8.4. The reluxation rate was 7.7%. This technique was shown to provide good clinical results, but only 69% of the patients were able to return to their prior sporting activity level. This particular problem was addressed by investigating the joint proprioception and the activity of the periarticular muscles. The results confirmed a persistent deficit of proprioception as well as a pathologic EMG pattern after anterior capsulolabral reconstruction, which may explain the problem of incomplete restoration of the function of the shoulder joint.

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Authors and Affiliations

  1. Unfallchirurgische Klinik, Klinikum Hildesheim

    R. Fremerey & B. Wippermann

  2. Klinik für Anästhesiologie und operative Intensivmedizin

    N. Freitag

  3. International Neuroscience Institute

    U. Bosch

  4. Unfallchirurgische Klinik, Henriettenstiftung Hannover

    P. Lobenhoffer

  5. Unfallchirurgische Klinik, Klinikum Hildesheim, Weinberg 1, 31141, Hildesheim

    R. Fremerey

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  1. R. Fremerey
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  2. N. Freitag
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  3. U. Bosch
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  4. P. Lobenhoffer
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  5. B. Wippermann
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Correspondence to R. Fremerey.

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Fremerey, R., Freitag, N., Bosch, U. et al. Sensomotorik nach Kapsellabrumrekonstruktion bei chronischer Schulterinstabilität. Unfallchirurg 108, 1038–1043 (2005). https://doi.org/10.1007/s00113-005-1011-3

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