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LBS-Tenotomie oder LBS-Tenodese?

Update LBS-Tenodesetechniken

LHB tenodesis or LHB tenotomy?

Update on LHB tenodesis techniques

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Zusammenfassung

Läsionen der langen Bizepssehne (LBS) verursachen glenohumerale Schmerzen, die durch eine proximale LBS-Desinsertion therapiert werden können. Ein Kraftverlust für die Ellenbogenflexion und Unterarmsupination nach Tenotomie ist beschrieben und kann auch mit einer Tenodese nicht immer komplett vermieden werden. Auch konsekutive „Popeye-sign“-Deformitäten und temporäre Bizepskrämpfe sind bekannt. Bis auf das vermehrt nach Tenotomie auftretende „Popeye sign“ kann bisher kein Konsensus über den Vorteil der Tenodese gefunden werden, wobei es an prospektiv randomisierten Studien zum Vergleich der Tenotomie mit suffizienten LBS-Tenodesetechniken mangelt. Hierbei werden neben offener und arthroskopisch subakromialer oder glenohumeraler Technik verschiedene Fixationsimplantate an supra- oder subpektoraler Position unterschieden. Als Goldstandard hat sich die intraossäre Sehnenfixation mit einer Interferenzschraube erwiesen. Vorteile der subpektoralen Technik sind die suffiziente Weichteildeckung und die Entfernung des intrakanalikulären Teils der LBS. Ein Nachteil der suprapektoralen arthroskopischen subakromialen im Vergleich zur glenohumeralen Technik ist die vermehrte subdeltoidale Weichteilsakrifizierung.

Abstract

Lesions of the long head of the biceps tendon (LHB) are painful but can be treated by biceps tenotomy. A decrease in elbow flexion force and lower arm supination force following tenotomy is well known and cannot be totally avoided by biceps tenodesis. A Popeye deformity and temporary cramps of the biceps muscle have been regularly described after LHB tenotomy. There is no consensus about the advantages of LHB tenodesis except the appearance of a Popeye deformity; however, there is a lack of prospective randomized trials comparing tenotomy with sufficient LHB tenodesis techniques. In this respect, in addition to arthroscopic subacromial, glenohumeral and open techniques, various implants for fixation at the suprapectoral and subpectoral positions are distinguished. The evaluation of intraosseous tendon fixation using an interference screw has yielded excellent results and is therefore considered to be the gold standard. Advantages of the subpectoral technique are sufficient soft tissue covering and removal of the intracanalicular part of the LHB. A disadvantage of the suprapectoral arthroscopic technique via the subacromial approach in comparison to the glenohumeral approach is the higher amount of soft tissue sacrificed when using the subacromial approach.

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Einhaltung ethischer Richtlinien

Interessenkonflikt

C. Ziskoven und R. Krauspe geben an, dass kein Interessenkonflikt besteht.

Der korrespondierende Autor weist auf folgende Beziehungen hin:

Dr. Th. Patzer ist als Referent und Instruktor für die Firmen Arthrex (Naples, FL/USA;

Karlsfeld) und Lima Corporate (San Daniele, I; Hamburg) tätig.

Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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  1. Orthopädische Klinik, Universitätsklinikum Düsseldorf, Moorenstraße 1–5, 40225, Düsseldorf, Deutschland

    Thilo Patzer MD, Christoph Ziskoven MD & Ruediger Krauspe MD, PhD

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  1. Thilo Patzer MD
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  2. Christoph Ziskoven MD
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  3. Ruediger Krauspe MD, PhD
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Correspondence to Thilo Patzer MD.

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Patzer, T., Ziskoven, C. & Krauspe, R. LBS-Tenotomie oder LBS-Tenodese?. Obere Extremität 9, 18–23 (2014). https://doi.org/10.1007/s11678-013-0238-9

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