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Superiore Kapselrekonstruktion: Ist die lange Bizepssehne vielleicht doch für etwas gut?

Einführung, Operationstechniken, biomechanische Daten und klinische Ergebnisse

Superior capsular reconstruction: is the long biceps tendon good for something after all?

Introduction, surgical techniques, biomechanical data and clinical outcome

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Zusammenfassung

Die Behandlung von posterosuperioren Rotatorenmanschettenmassenrupturen ist komplex. Der superioren Kapselrekonstruktion wurde in den letzten Jahren vermehrt Aufmerksamkeit geschenkt. Die Entnahmemorbidität eines Tensor-fascia-lata-Autografts und die hohen Kosten von Allografts machen die lange Bizepssehne (LBS) zu einer interessanten Graft-Alternative. Vorteile sind v. a. die geringe Entnahmemorbidität, eine vergleichsweise einfache Operationstechnik und geringere Kosten. Limitiert ist das Verfahren bei vorliegenden Beeinträchtigungen der LBS (Partialrupturen, SLAP-Läsionen [„superior labrum anterior and posterior“]). Zudem ist in Revisionsfällen die LBS nicht immer vorhanden. Die LBS kann als Einfach- oder Mehrfachstrang zwischen dem Oberrand des Glenoids und dem Tuberculum majus gespannt werden. Der native Ursprung wird meist belassen. Die Fixation am Tuberculum majus kann in Knotentechnik oder knotenlos erfolgen. Distal dieser Fixierung kann eine Tenotomie, subpektorale Tenodese oder keine weitere Therapie erfolgen. Verschiedene bisher publizierte biomechanische Daten konnten v. a. eine verringerte superiore Translation des Humeruskopfes durch eine SCR-LBS („superior capsular reconstruction“) beobachten. Erste klinische Daten zeigen gute Ergebnisse in den PROMs („patient reported outcome measures“) und teilweise verringerte Rerupturraten. Die klinischen Ergebnisse der SCR unter Verwendung der LBS scheinen darüber hinaus vergleichbar zu anderen Grafts zu sein. Jedoch fehlt es aktuell noch an qualitativ hochwertigeren Studien mit längerem Follow-up.

Abstract

Treatment of massive posterosuperior rotator cuff tears is complex. Therefore, superior capsule reconstruction (SCR) has received increased attention in recent years. Donor site morbidity of the tensor fascia lata autograft as well as high cost and increased failure rates of allografts support the use of the long biceps tendon (LBT) as a viable alternative. The main advantages include the low donor site morbidity, low costs and a less complex surgical technique. However, the procedure is limited in case of existing impairments of the long biceps tendon such as partial ruptures or superior labral anterior posterior (SLAP) lesions. Moreover, especially in revisions procedures, the biceps tendon is not always available. The LBT can be fixed as a single or multiple strand between the upper edge of the glenoid and the greater tuberosity. The native origin is usually left untreated. Fixation on the greater tuberosity can be done with suture anchors or in a knotless manner. Distal to this fixation, tenotomy, subpectoral tenodesis or no further treatment is described. Biomechanical data published to date have primarily observed reduced superior translation of the humeral head after SCR-LBT. Moreover, clinical data show good results in patient-reported outcome measures (PROMs) and reduced rerupture rates. Furthermore, the clinical results after SCR-LBT seem to be comparable to the results of SCR using other grafts. However, high-quality studies with longer follow-ups are needed.

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Authors and Affiliations

  1. Klinik für Arthroskopische Chirurgie, Sporttraumatologie und Sportmedizin, BG Klinikum Duisburg, Duisburg, Deutschland

    Michael Manzke

  2. Abteilung für Schulterchirurgie und Sporttraumatologie, Schön-Klinik Lorsch, Weilhelm-Leischner-Str. 10, 64653, Lorsch, Deutschland

    Olaf Lorbach

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Correspondence to Olaf Lorbach.

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M. Manzke und O. Lorbach geben an, dass kein 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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Manzke, M., Lorbach, O. Superiore Kapselrekonstruktion: Ist die lange Bizepssehne vielleicht doch für etwas gut?. Obere Extremität 18, 249–254 (2023). https://doi.org/10.1007/s11678-023-00764-6

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