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SLAP-Repair („superior labrum anterior posterior“) vs. Tenodese beim Sportler: Ist ein Repair noch zeitgemäß?

Superior labrum anterior posterior (SLAP) repair vs. tenodesis in athletes: is repair still the best option?

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Zusammenfassung

Die Entstehung von SLAP-Läsionen („superior labrum anterior posterior“) insbesondere bei Überkopfsportlern wird kontrovers diskutiert und weist letztendlich eine multifaktorielle Genese auf. Gerade im Hinblick auf den gewünschten Therapieerfolg ist es essenziell, sich mit den (anhaltenden) Belastungen des SLAP bei Sportlern auseinanderzusetzen. Die Diagnostik isolierter SLAP-Läsionen ist trotz multipler klinischer Tests und hochauflösender Bildgebung schwierig und wird nicht selten durch den Ausschluss anderer Pathologien erzielt. Die Behandlung der SLAP-Läsion richtet sich nach Rupturtyp, Patientenalter, Begleitpathologien und funktionellem Anspruch des Patienten. Primär sollte ein konservativer Therapieversuch erfolgen, um funktionelle Defizite (u. a. GIRD-Syndrom [„glenohumeral internal rotation deficit“] und Skapulaprotraktion) zu adressieren. Bei SLAP-Läsion mit traumatischer Genese, Patientenalter < 25 Jahre, sportlich Aktiven und/oder Überkopfsportlern kann der primäre SLAP-Repair gute Ergebnisse mit hoher Rückkehr zum ursprünglichen Sportniveau ermöglichen. Für degenerative SLAP-Läsionen und Patienten > 25 Jahren zeigt sich die LBS-Tenodese (lange Bizepssehne) dem Repair überlegen.

Abstract

The etiology of SLAP (superior labrum anterior posterior) lesions, particularly in overhead athletes, is a matter of controversy and ultimately has a multifactorial genesis. It is essential to deal with the (persistent) loads on the SLAP in athletes, especially when considering the success of any treatment. Despite multiple clinical tests and high-resolution imaging, the diagnosis of isolated SLAP lesions is difficult and is often achieved by exclusion of other pathologies. The treatment of the SLAP lesion depends on the type of rupture, patient age, concomitant pathologies and the patient’s functional demands. A conservative therapy attempt should primarily be made to address functional deficits, including glenohumeral internal rotation deficit (GIRD) syndrome and scapular protraction. In case of SLAP lesions with a traumatic origin, patient age < 25 years, active athletes and/or overhead athletes, primary SLAP repair can enable good results with a high return to the original level of sport. For degenerative SLAP lesions and older patients (> 25 years), it has been shown that biceps tenodesis is advantageous.

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Authors and Affiliations

  1. Sportorthopädie, Universitätsklinikum rechts der Isar, TU München, München, Deutschland

    Lucca Lacheta

  2. Deutsches Schulterzentrum, ATOS Klinik München, München, Deutschland

    Frank Martetschläger

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  1. Lucca Lacheta
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  2. Frank Martetschläger
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Correspondence to Frank Martetschläger.

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Interessenkonflikt

F. Martetschläger ist Berater der Fa. Arthrex und Fa. Exatech. L. Lacheta gibt an, dass kein relevanter Interessenkonflikt besteht.

Für diesen Beitrag wurden von den Autor/-innen keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

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Lacheta, L., Martetschläger, F. SLAP-Repair („superior labrum anterior posterior“) vs. Tenodese beim Sportler: Ist ein Repair noch zeitgemäß?. Obere Extremität 18, 232–239 (2023). https://doi.org/10.1007/s11678-023-00763-7

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