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PASTA-Läsionen – Debridement versus Naht

PASTA-lesions – debridement versus repair

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Zusammenfassung

Hintergrund

Die als PASTA-Läsionen bezeichneten Partialläsionen der artikularseitigen Supraspinatussehne stellen nach wie vor eine diagnostische und therapeutische Herausforderung dar.

Diagnostik

Bei der Diagnostik von PASTA-Läsionen spielt die arthroskopische Evaluation der Supraspinatussehne die entscheidende Rolle. Eine präoperative Bildgebung ist in der Regel nicht ausreichend um eine therapeutische Entscheidung zu treffen.

Operationstechnik

Bei nichtsignifikanten Partialläsionen < 50 % Sehnendurchmesser wird ein einfaches Debridement durchgeführt. Bei den Nahttechniken kann zwischen der transtendinösen Nahttechnik und Sehnenrekonstruktion nach Komplettierung der Partialruptur unterschieden werden. Bei PASTA-Läsionen wird eine Naht der Sehne einem Debridement vorgezogen.

Ergebnisse

In der Literatur finden sich keine Hinweise auf die Überlegenheit einer der beiden Nahttechniken. Prospektiv-randomisierte Studien, die ein Debridement und eine Sehnennaht bei PASTA-Läsionen vergleichen, finden sich ebenfalls nicht. Technisch erscheint die Komplettierung und Rekonstruktion analog zur Behandlung von kompletten Supraspinatusrupturen reproduzierbarer zu sein.

Abstract

Background

Partial articular supraspinatus tendon avulsions (PASTA) lesions remain challenging with regard to diagnosis and treatment.

Diagnostics

For the diagnosis of PASTA lesions, arthroscopic evaluation of the supraspinatus tendon is key. Preoperative imaging alone is usually not sufficient to make the treatment decision.

Operative technique

For non-significant partial tears of less than 50 % of the tendon thickness a simple debridement is indicated. Two basic repair techniques, a transtendon repair technique and a repair after tear completion, can be distinguished. In PASTA lesions, a repair is generally preferred to debridement.

Results

Results in the literature do not favor one repair technique over the other. Prospective randomized trials comparing debridement with repair are lacking in the literature. From a technical standpoint tear completion and repair seem to be a bit more reproducible.

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Authors and Affiliations

  1. Klinik und Poliklinik für Allgemeine Orthopädie und Tumororthopädie, Universitätsklinikum Münster, Albert-Schweitzer-Campus 1, Gebäude A1, 48149, Münster, Deutschland

    D. Liem, G. Gosheger & T. Vogler

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  1. D. Liem
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  2. G. Gosheger
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  3. T. Vogler
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Correspondence to D. Liem.

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D. Liem, G. Gosheger und T. Vogler geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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Liem, D., Gosheger, G. & Vogler, T. PASTA-Läsionen – Debridement versus Naht. Orthopäde 45, 125–129 (2016). https://doi.org/10.1007/s00132-015-3201-1

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  • DOI: https://doi.org/10.1007/s00132-015-3201-1

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