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Rekonstruktion der Rotatorenmanschette: Single-row oder Double-row

Klinische und biomechanische Ergebnisse

Rotator cuff repair: single- vs double-row

Clinical and biomechanical results

Der Orthopäde volume 45, pages 118–124 (2016)Cite this article

Zusammenfassung

Hintergrund

Ziel der Refixation von Rupturen der Rotatorenmanschette ist eine hohe mechanische Stabilität als Voraussetzung für eine biologisch sichere Wiederherstellung des Sehnen-Knochen-Komplexes. Trotzdem die Anzahl von Publikationen zum Thema der Rotatorenmanschettenreparatur deutlich angestiegen ist, bestehen jedoch weiterhin Kontroversen bezüglich der Technik ihrer operativen Behandlung.

Fragestellung

Ziel der Arbeit ist es, eine Übersicht über die aktuell publizierten Ergebnisse biomechanischer und klinischer Studien zur Refixation der Rotatorenmanschette in Single-row- und Double-row-Technik zu geben.

Material und Methoden

Die Darstellung basiert auf einer Literaturrecherche der Datenbanken PubMed, Embase und Cochrane zum Thema der klinischen und biomechanischen Ergebnisse nach Single-row- und Double-row-Refixation.

Ergebnisse

Weder die biomechanische noch die klinische Evidenzlage können die Verwendung des Double-row-Konzeptes grundsätzlich für die Behandlung jeder Ruptur der Rotatorenmanschette empfehlen. Lediglich Rupturen mit einer Größe von > 3 cm zeigen sowohl bildgebend als auch klinisch-funktionell bessere Ergebnisse im Vergleich zu einer Versorgung mit der Single-row-Technik.

Diskussion

Trotz deutlicher Zunahme der Veröffentlichungen zur operativen Versorgung der Rotatorenmanschettenruptur in den vergangenen Jahren wurden die klinischen Ergebnisse bisheriger Publikationen nicht wesentlich verbessert. Eindeutige Informationen und Algorithmen, aus denen sich die optimale Versorgung dieser Entität ableiten lassen, sind weiterhin nur unzureichend. Aufgrund ihrer geringen Wirtschaftlichkeit und der aktuell unsicheren Evidenzlage kann die Double-row-Technik nicht generell zur Versorgung aller Rotatorenmanschettenrupturen empfohlen werden.

Abstract

Background

The goal of rotator cuff repair is a high initial mechanical stability as a requirement for adequate biological recovery of the tendon-to-bone complex. Notwithstanding the significant increase in publications concerning the topic of rotator cuff repair, there are still controversies regarding surgical technique.

Objectives

The aim of this work is to present an overview of the recently published results of biomechanical and clinical studies on rotator cuff repair using single- and double-row techniques.

Materials and methods

The review is based on a selective literature research of PubMed, Embase, and the Cochrane Database on the subject of the clinical and biomechanical results of single- and double-row repair.

Results

In general, neither the biomechanical nor the clinical evidence can recommend the use of a double-row concept for the treatment for every rotator cuff tear. Only tears of more than 3 cm seem to benefit from better results on both imaging and in clinical outcome studies compared with the use of single-row techniques.

Conclusions

Despite a significant increase in publications on the surgical treatment of rotator cuff tears in recent years, the clinical results were not significantly improved in the literature so far. Unique information and algorithms, from which the optimal treatment of this entity can be derived, are still inadequate. Because of the cost-effectiveness and the currently vague evidence, the double-row techniques cannot be generally recommended for the repair of all rotator cuff tears.

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Author information

Affiliations

  1. Orthopädie Aukamm-Klinik Wiesbaden, Leibnizstr. 21, 65191, Wiesbaden, Deutschland

    M. H. Baums

  2. Abteilung Orthopädie, Universitätsmedizin Göttingen (UMG), Georg-August-Universität, Göttingen, Deutschland

    M. H. Baums & H.-M. Klinger

  3. Klinik für Orthopädie und Unfallchirurgie, St. Josef-Hospital im Katholischen Klinikum Bochum, Ruhr-Universität-Bochum (RUB), Bochum, Deutschland

    T. Kostuj

  4. UOC Ortopedia e Traumatologia, Policlinico Universitario Campus Bio-Medico, Rom, Italien

    R. Papalia

Authors
  1. M. H. Baums
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  2. T. Kostuj
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  3. H.-M. Klinger
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  4. R. Papalia
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Corresponding author

Correspondence to M. H. Baums.

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M. H. Baums, T. Kostuj, H.-M. Klinger und R. Papalia geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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Baums, M.H., Kostuj, T., Klinger, HM. et al. Rekonstruktion der Rotatorenmanschette: Single-row oder Double-row. Orthopäde 45, 118–124 (2016). https://doi.org/10.1007/s00132-015-3210-0

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Schlüsselwörter

  • Rotatorenmanschette
  • Sehnenverletzungen
  • Ruptur
  • Nahttechniken
  • Arthroskopie

Keywords

  • Rotator cuff
  • Tendon injuries
  • Rupture
  • Suture techniques
  • Arthroscopy