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Tenodese der langen Bizepssehne – wo und wie denn jetzt?

Tenodesis of the long head of the biceps—when and how exactly?

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Zusammenfassung

Pathologien der langen Bizepssehne (LBS) sind eine häufige Ursache von Schulterschmerzen und treten isoliert oder in Verbindung mit z. B. Rotatorenmanschettenläsionen auf. Eine adäquate Therapie dieser Pathologien ist entscheidend für eine erfolgreiche Behandlung der Patienten. Neben der Tenotomie, die mit Popeye-Deformitäten, Muskelkrämpfen und Kraftverlust einhergehen kann, wurden viele verschiedene Verfahren zur Tenodese der LBS entwickelt. Diese unterscheiden sich im wesentlich durch die Lokalisation (suprapektoral, subpektoral), die Fixierungsmethode (Onlay vs. Inlay), die verwendeten Implantate (Weichteiltenodese, Anker, Interferenzschrauben, Flip-Button etc.) und die Operationstechnik (offen vs. arthroskopisch). Insgesamt zeichnen sich die meisten Verfahren durch eine gute Durchführbarkeit und eine hohe Primärstabilität aus, eine signifikante Überlegenheit einer bestimmten Technik konnte bisher nicht nachgewiesen werden. Jedoch lässt sich festhalten, dass für Patienten mit hohem funktionellem Anspruch eine Tenodese vorteilhaft zu sein scheint, eine isolierte Tenotomie dagegen eher bei älteren Patienten mit geringem funktionellem Anspruch durchgeführt werden sollte.

Abstract

Pathologies of the long head of the biceps are a common cause of shoulder pain and are frequently associated with other lesions such as rotator cuff tears. Adequate management of these lesions is crucial for successful treatment of patients. In addition to tenotomy, which can be associated with Popeye deformities, muscle cramps and loss of strength, many different procedures have been developed for tenodesis of the long head of the biceps. These differ regarding location (suprapectoral vs. subpectoral), fixation technique (onlay vs. inlay), implants used (soft tissue tenodesis, anchor, interference screws, flip button, etc.) and surgical technique (open vs. arthroscopic). Overall, most techniques can be performed easily and are characterized by high primary stability. So far, there is no evidence that one distinct technique is superior to others. However, for patients with high functional demands, tenodesis with high primary stability seems to be advantageous and tenotomy may be preferable in elderly patients with low functional demands.

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Authors and Affiliations

  1. Klinik für Unfall‑, Hand- und orthopädische Chirurgie, Herz-Jesu-Krankenhaus Münster, Westfalenstraße 109, 48165, Münster, Deutschland

    Maria Sommer,  Nils Geisendörfer &  Benedikt Schliemann

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  1. Maria Sommer
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  2. Nils Geisendörfer
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  3. Benedikt Schliemann
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Correspondence to Benedikt Schliemann.

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M. Sommer, N. Geisendörfer und B. Schliemann 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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Sommer, M., Geisendörfer, N. & Schliemann, B. Tenodese der langen Bizepssehne – wo und wie denn jetzt?. Obere Extremität 18, 240–248 (2023). https://doi.org/10.1007/s11678-023-00767-3

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  • DOI: https://doi.org/10.1007/s11678-023-00767-3

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