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Offene Rekonstruktion der Rotatorenmanschette

Open reconstruction of the rotator cuff

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Zusammenfassung

Die Erfolgsraten nach offener Rekonstruktionen der Rotatorenmanschette hinsichtlich Schmerzbefreiung und Verbesserung der Funktion sind in einer Vielzahl von Studien dokumentiert. Zumindest für kleine bis mittlere Defekte stellt sich gegenwärtig die Frage, ob diese nicht auch arthroskopisch mit günstigen Ergebnissen behandelt werden können. Derzeit sind deren Ergebnisse jedoch, gemessen an den Erfolgsraten der offenen Verfahren, hinsichtlich der Rezidivdefekte insbesondere bei großen Defekten (mehr als 2 Sehnendefekte) noch nicht ebenbürtig.

Die offene Rekonstruktion ist derzeit noch für alle Patienten, die eine bestmögliche Funktion und Kraft wünschen, sowie für ältere Patienten zu bevorzugen. Diese weist zwar die niedrigere Rate an Rerupturen auf, besitzt jedoch gegenüber den arthroskopischen Verfahren eine höhere, zugangsbedingte Morbidität. Die Indikationsstellung bedarf unter Berücksichtigung neuerer Aspekte in der bildgebenden Diagnostik und spezialisierten Operationsverfahren eines erfahrenen, in diesem Spezialgebiet geschulten Chirurgen, um unbefriedigende Resultate zu vermeiden. Bei irreparablem 2-Sehnen-Defekt mit fettiger Infiltration der Muskulatur und deutlichem Funktionsverlust ist bei aktiven Patienten eine Muskeltransposition zu erwägen. Diese kann im mittel- bis langfristigen Verlauf zu einer funktionellen Verbesserung, jedoch keiner völligen Wiederherstellung der Funktion führen.

Abstract

Success rates relating to relief from pain and improved function following open reconstruction of the rotator cuff have been documented in many studies. At least for small to medium-size tears the question currently arises of whether an arthroscopic repair would not also give good treatment results. At present, however, the results of arthroscopic repair are not yet comparable to those yielded by the open techniques, at least in terms of recurrent defects especially in the case of massive tears (affecting more than two tendons).

Open surgical repair is currently still recommended for all patients who require maximal postoperative function and strength and for elderly patients. Open repairs have a lower rate of re-rupture than arthroscopic repairs, but arthroscopic repair offers the benefits of lower morbidity. The decision on which technique is indicated should be made by an experienced surgeon with special training in this area and with due consideration for newer aspects in diagnostic imaging techniques, so as to avoid unsatisfactory results. In certain cases of irreparable cuff tears affecting two tendons and with fatty infiltration of the muscle and substantial loss of function muscle transfer can be considered in active patients; this can offer some functional improvement in the medium to long term, but do not lead to full restoration of function.

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  1. Orthopädische Klinik König-Ludwig-Haus, Brettreichstr. 11, 97074, Würzburg, Deutschland

    Frank Gohlke, O. Rolf & D. Böhm

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  1. Frank Gohlke
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Correspondence to Frank Gohlke.

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Gohlke, F., Rolf, O. & Böhm, D. Offene Rekonstruktion der Rotatorenmanschette. Orthopäde 36, 834–847 (2007). https://doi.org/10.1007/s00132-007-1135-y

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