Zusammenfassung
Einleitung
Eine zunehmende Anzahl operativ versorgter SLAP-Läsionen in der letzten Dekade fordert die Untersuchung langfristiger klinischer Resultate sowie die Herausarbeitung möglicher negativer prädiktiver Faktoren, die einen Einfluss auf das postoperative Outcome haben könnten.
Patienten und Methoden
Insgesamt 60 von 77 Patienten (Follow-up-Rate 78 %) konnten mit einer Nachbeobachtungsdauer von 57,7 Monate (Spannweite 26–94 Monate) mittels Constant-Murley Score (CMS), Rowe Score (RS) und Subjective Shoulder Value (SSV) nachuntersucht werden. Es erfolgte eine Unterteilung der Patienten hinsichtlich Alter zum Zeitpunkt der Operation (OP), begleitender Rotatorenmanschetten (RM)-Pathologie, Vorliegen einer isolierten SLAP („superior labrum anterior to posterior“)-Läsion, Ätiologie der Verletzung sowie einer zum Zeitpunkt der OP arthroskopisch festgestellten Chondromalazie.
Ergebnisse
Der mediane adaptierte CMS lag bei 89 % (Spannweite 38–106 %). Im Durchschnitt wurde die Funktionsfähigkeit der operierten Schulter im SSV mit 90 % angegeben. Insgesamt 87 % der Patienten waren mit dem OP-Ergebnis sehr zufrieden oder zufrieden. Das Alter, Begleitläsionen im Allgemeinen sowie Läsionen der RM im Speziellen hatten in dieser Untersuchung keinen Einfluss auf das postoperative Resultat. Patienten mit intraoperativ vorbestehendem Chondralschaden bewerteten die Funktionsfähigkeit ihrer Schulter im Rahmen des SSV signifikant (p = 0,0221) schlechter. Im absoluten und alterskorrelierten CMS (p = 0,0104) und im SSV (p = 0,0418) zeigten Patienten mit ätiologisch ursächlichem Trauma signifikant höhere Werte als Patienten der Gruppe ohne ursächliches Trauma.
Diskussion
Klinische Resultate nach Rekonstruktion der SLAP-Läsion sind im Langzeitverlauf über durchschnittlich 5 Jahre stabil. Als prädiktive Faktoren für ein schlechteres postoperatives Outcome lassen sich die degenerative und rezidivierend mikrotraumatische Ätiologie sowie eine vorbestehende Knorpelschädigung darstellen.
Abstract
Introduction
The increasing number of surgically treated superior labrum anterior to posterior (SLAP) lesions in the past decade calls for an investigation of the long-term clinical results and assessment of possible predictive factors that could have an influence on the postoperative outcome.
Patients and methods
Out of 77 patients 60 were treated surgically with arthroscopic SLAP repair. Of these 78 % of the patients were available at final follow-up and the mean duration of follow-up was 57.7 months (range 26−94 months). All patients were followed up clinically by evaluation of the Constant-Murley (CMS), Rowe (RS) and the subjective shoulder value (SSV) scores. Patients were subdivided according to age at time of surgery, concomitant rotator cuff pathology, existing isolated SLAP lesions, existing accompanying injury, etiology of injury and pre-existing cartilage lesion at the time of surgery.
Results
The median age and gender-adjusted CMS was 89 % (range 38–106 %). The average functionality of the operated shoulder in SSV was 90 % and 87 % of patients were very satisfied or satisfied with the clinical outcome. Both the age and generally accompanying lesions and in particular partial lesions of the rotator cuff had no effect on the postoperative outcome. Pre-existing cartilage lesions resulted in significantly lower functionality of the shoulder as part of the SSV (p = 0.0221).Both absolute and age and gender-related CMS (p = 0.0104) and SSV (p = 0.0418) were significantly higher in the posttraumatic group than the group with degenerative etiology.
Discussion
Clinical results after arthroscopic repair of SLAP lesions are stable in an average long-term of approximately 5 years. The degenerative and recurrent microtraumatic etiology and pre-existing cartilage damage can be predictive factors for a worse postoperative outcome.
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L. J. Lehmann, M. Moursy, K. Cafaltzis und C. Lederer geben an, dass kein Interessenkonflikt besteht.
Die Ethikkommission der Fakultät prüfte und genehmigte das Studienprotokoll. Ziele und Durchführung der Studie wurden den Patienten eingehend erläutert. Alle an der Studie beteiligten Patienten gaben eine schriftliche Einverständniserklärung ab.
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Lehmann, L., Moursy, M., Cafaltzis, K. et al. Langzeitresultate nach arthroskopischem SLAP-Repair. Obere Extremität 9, 38–44 (2014). https://doi.org/10.1007/s11678-014-0246-4
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DOI: https://doi.org/10.1007/s11678-014-0246-4