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Der Einfluss der Sehnenheilung nach arthroskopischer Supraspinatussehnennaht auf das klinische Ergebnis

Eine prospektive, MRI-kontrollierte Studie

Influence of tendon healing after arthroscopic rotator cuff repair on clinical outcome

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Summary

Background

The reported functional results of rotator cuff repair performed arthroscopically have been good. Only little is known about the cuff integrity after arthroscopic repair and how it influences the outcome. The aim of the study was to set a baseline of what rate of tendon healing or retears to expect and how cuff integrity alters the outcome.

Methods

A total of 53 consecetive patients with an isolated supraspinatus tendon fear were arthroscopically operated and their tendons repaired. All pre- and postoperative data were prospectively collected. At a minimum follow-up after 24 months (average 26.4 months) the integrity of the cuff was evaluated by an open MRI and the patients' function and satisfaction were documented and graded to the sex- and age-related Constant-score also using a dynamometer for strength testing.

Results

The re-tear rate was 24.5% with 13 non-healed tendons. The Constant score of all patients improved significantly. The scores of the patients with a re-tear were significantly lower than those of the patient with an intact cuff. This was due to a poorer performance in strength testing. The other categories of the Constant score did not show any differences. The age of the patients with a re-tear was significantly higher. With the exception of age we did not find any negative prognostic factor for a re-tear, and with the exception of re-tear no other factor influenced the Constant score.

Conclusions

Arthroscopic supraspinatus tendon repair yields a re-tear rate of 25% which is comparable with the results of open or mini/open repair. Cuff integrity influences postoperative strength and Constant score. Patients older than 65 years show a higher re-tear rate. Level of evidence: Therapeutic Level IV.

Zusammenfassung

Einleitung

Die guten klinischen Ergebnisse der arthroskopischen Rotatorenmanschettenrekonstruktion sind in der Literatur beschrieben. Inwieweit die rekonstruierten Sehnen jedoch wirklich einheilen und welchen Einfluss dies auf das Ergebnis hat, ist für die arthroskopischen Techniken nur spärlich beschrieben.

Ziel der Arbeit

ist es, die Rerupturrate nach arthroskopischer Rekonstruktion isolierter Supraspinatussehnenläsionen zu bestimmen und zu evaluieren, welchen Einfluss die Einheilung auf das postoperative klinische Ergebnis hat.

Material und Methode

53 Patienten wurden prospektiv in diese Studie aufgenommen. Bei allen erfolgte die arthroskopische Rekonstruktion einer isolierten Supraspinatussehnenläsion in Nahtankertechnik. Die prä- und postoperativ erhobenen Daten wurden anhand des alter- und geschlechtskorrelierten Constant-Scores ausgewertet. Die Nachuntersuchung fand nach frühestens nach 24 Monaten im Durchschnitt nach 26,4 Monaten statt. Bei dieser Untersuchung erfolgte eine kernspintomographische Kontrolle der Einheilung der Sehne und eine Kraftmessung mit einem Dynamometer.

Ergebnisse

Es konnte eine Rerupturrate von 24,5% ermittelt werden. Der Constant-Score aller Patienten verbesserte sich von 53,4% (23–80%) auf 84,3 % (62,5–99,3 %) signifikant (p<0,0001). Der Constant-Score der Patienten mit einer eingeheilten Sehne war mit 86 % signifikant besser (p<0,0095) als der von Patienten mit einer Reruptur (79 %). Die Kraft war das entscheidende Kriterium für die Unterschiede im Constant-Score, wohingegen die Kategorien Schmerz, Bewegungsumfang und Tätigkeiten des täglichen Lebens keine Unterschiede aufwiesen. Das Alter der Patienten mit Reruptur war ebenfalls signifikant höher (65,3 vs. 59,5 Jahre; p<0,012).

Zusammenfassung

Die arthroskopische Rekonstruktion der Supraspinatussehne erbringt gute klinische Ergebnisse bei einer Rerupturrate von 24,5%. Die Einheilung hat Einfluss auf die postoperative Kraft und damit auf den Gesamt-Constant-Score. Patienten älter als 65 Jahre zeigten eine höhere Rerupturrate.

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Authors and Affiliations

  1. ATOS-Klinik, Bismarckstraße 9–15, 69115, Heidelberg, Germany

    S. Lichtenberg,  D. Liem,  P. Magosch &  P. Habermeyer

Authors
  1. S. Lichtenberg
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  2. D. Liem
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  3. P. Magosch
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  4. P. Habermeyer
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Corresponding author

Correspondence to S. Lichtenberg.

Additional information

Es handelt sich bei dieser Arbeit um eine Übersetzung des folgenden Artikels: Lichtenberg S, Liem D,Magosch P,Habermeyer P (2006) Influence of tendon healing after arthroscopic rotator cuff repair on clinical outcome using single row Mason-Allen suture technique – a prospective, MRI controlled study.Knee Surg Sports Traumatol Arthrosc 14:1200–1206.

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Lichtenberg, S., Liem, D., Magosch, P. et al. Der Einfluss der Sehnenheilung nach arthroskopischer Supraspinatussehnennaht auf das klinische Ergebnis. Obere Extremität 1, 50–57 (2006). https://doi.org/10.1007/s11678-006-0009-y

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  • DOI: https://doi.org/10.1007/s11678-006-0009-y

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