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Klinische und magnetresonanztomographische Ergebnisse nach arthroskopischer Rotatorenmanschettenrekonstruktion in „Double-row“-Technik

Eine serielle Studie

Clinical and MRI results after arthroscopic rotator cuff repair using the double-row technique

A consecutive study

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Zusammenfassung

Hintergrund

Die arthroskopische Rekonstruktion von Rotatorenmanschetten (RM)-Rupturen in „Double-row“-Technik wird mit verbesserter anatomischer Rekonstruktion in Zusammenhang gebracht. Ziel dieser Studie war es, strukturelle und funktionelle Ergebnisse im Verlauf darzustellen.

Methodik

Es wurden 20 Patienten mit mittelgroßen Rupturen prospektiv erfasst. Intraoperativ wurden Rupturlokalisation, -größe, -form, sowie der Retraktionsgrad erhoben. Alle Patienten wurden nach 6, 12 und 26 Wochen nachuntersucht. Die magentresonanztomographische Kontrolle erfolgte nach einem Standardprotokoll im Niederfeld-System. Hier wurden die Sehnenintegration sowie Signalveränderungen der Sehne und der Bursae, Größe des Knöchenmarködems mit Ankerverhalten bzw. -lage, die Muskelatrophie und der Grad der Muskelverfettung bestimmt.

Ergebnisse

Bei der 6-Wochen-Kontrolle fanden sich noch Restbeschwerden mit Schmerzen. Der Constant Murley Score (34 Punkte) zeigte niedrigere Werte als präoperativ (52 Punkte). Der Constant Murley Score nach 12 Wochen zeigte einen signifikanten Anstieg von 52 auf 61 Punkte. Ebenso konnte das präoperative Kraftniveau erreicht werden. Die Schmerzen reduzierten sich bei allen Patienten. Signalveränderungen in der Sehne und den Bursae sowie das Knochenmarködem waren deutlich rückläufig und eine Sehnenintegration war in 87% der Fälle bestimmbar. Nach 26 Wochen stieg der Constant Murley Score auf 79 Punkte. Signalveränderungen in der Sehne und den Bursae sowie das Knochenmarködem normalisierten sich.

Schlussfolgerungen

Die arthroskopische „Double-row“-Rekonstruktion bei mittelgroßen RM-Rupturen stellt eine sichere Behandlungsmethode dar. Die in der MRT-Untersuchung erhobenen Parameter korrelieren mit den klinischen Ergebnissen.

Abstract

Introduction

Arthroscopic rotator cuff repair using the double-row technique is associated with improved anatomical results. The aim of our study was to compare clinical and structural results after arthroscopic reconstruction.

Methods

A total of 40 patients with a mid-size tear were included. Intraoperatively, the rupture location and size, rupture shape and retraction were documented. All patients underwent an evaluation after 6, 12, 26 and 52 weeks. The MRI examination was performed using a standard protocol in a low-field MRI. The tendon integrity, signal intensity in tendon and bursae, the size of the bone edemas, signal characteristics of the anchors, and muscular atrophy, and fatty degeneration were determined.

Results

All patients had problems including some pain at the 6-week follow-up. the Constant Murley score (34 points) was lower than that recorded preoperatively (52 points). In the MRI, one re-rupture was identified. After 12 weeks, the Constant Murley score showed an explicit increase (from 52 to 61 points). In addition, patients were able to achieve their preoperative force levels on average. All patients experienced some degree of pain relief. After 26 weeks, the Constant Murley score had risen to 79 points. The signal intensity in tendons and bursae, and the bone edemas had normalized.

Conclusions

Arthroscopic double-row repair of rotator cuff tears is a safe procedure, the structural results in the MRI correlated with the clinical results.

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Abbreviations

ACG:

Akromioklavikulargelenk

ADL:

„Activities of daily living“ (Aktivitäten des täglichen Lebens)

ARO:

Außenrotation

IRO:

Innenrotation

HU:

„Houndsfield unit”

MRT:

Magnetresonanztomographie

RM:

Rotatorenmanschette

ROM:

„Range of motion“ (Bewegungsumfang)

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Authors and Affiliations

  1. Sportklinik Stuttgart, Taubenheimstr. 8, 70372, Stuttgart, Deutschland

    F. Pfalzer, D. Endele, J. Huth, G. Bauer & F. Mauch

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  1. F. Pfalzer
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  2. D. Endele
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  3. J. Huth
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  4. G. Bauer
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  5. F. Mauch
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Correspondence to F. Pfalzer.

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Pfalzer, F., Endele, D., Huth, J. et al. Klinische und magnetresonanztomographische Ergebnisse nach arthroskopischer Rotatorenmanschettenrekonstruktion in „Double-row“-Technik. Obere Extremität 6, 267–274 (2011). https://doi.org/10.1007/s11678-011-0117-1

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