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Management von Redefekten der Rotatorenmanschette

Management of recurrent rotator cuff defects

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Zusammenfassung

Auch wenn die konsequente Weiterentwicklung aktueller Operationstechniken immer stabilere Rekonstruktionen erlaubt, stellen Redefekte der Rotatorenmanschette nach wie vor die Hauptkomplikation nach Rotatorenmanschettenrekonstruktionen dar. Diese strukturellen Redefekte unterliegen vornehmlich einer multifaktoriellen Genese. Für das therapeutische Management ist eine dezidierte Ursachenanalyse obligat. Zudem ist es abhängig vom subjektiven Beschwerdebild des Patienten, dem objektiven Funktionszustand, den pathomorphologischen Veränderungen der muskulotendinösen Einheit und ossären Veränderungen des Glenohumeralgelenks. Neben einem „skilfull neglect“ bzw. konservativen Therapiemaßnahmen kommt bei entsprechender Indikation der arthroskopischen Re-Rekonstruktion ein zunehmender Stellenwert hinzu. Irreparable Defektsituationen können je nach Beschwerdebild und Ausdehnung der Ruptur mit einem Sehnentransfer (Latissimus-dorsi- oder Pectoralis-major-Transfer) bzw. der Implantation einer inversen Endoprothese therapiert werden. Insgesamt sind die Ergebnisse einer Revisionsoperation denen eines Primäreingriffs unterlegen, so dass der Patient entsprechend aufgeklärt werden muss.

Abstract

Even though surgical techniques continue to evolve, reported recurrent defect rates after primary rotator cuff reconstruction remain high. As structural failure after RC reconstruction is believed to be multifactorial, management of recurrent defects is dependent on the clinical presentation, objective shoulder function, pathomorphological alterations of the musculotendinous unit, and osseous changes of the glenohumeral joint. Consequently, a firm analysis of potential failure causes is mandatory. Apart from skillful neglect and/or conservative management, arthroscopic revision of failed cuff repairs appears to be a promising procedure. In case of an irreparable rotator cuff, extraanatomic tendon transfers (latissimus dorsi or pectoralis major transfer) or reverse shoulder arthroplasty can be considered. Notably, results after re-reconstruction or open revision using tendon transfers are inferior compared to primary interventions. Thus, patients’ expectations need to be adjusted accordingly.

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  1. Centrum für Muskuloskeletale Chirurgie (CMSC), Campus-Mitte und Campus-Virchow, Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Deutschland

    C. Gwinner,  P. Moroder,  C. Gerhardt &  M. Scheibel

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  1. C. Gwinner
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Correspondence to M. Scheibel.

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Gwinner, C., Moroder, P., Gerhardt, C. et al. Management von Redefekten der Rotatorenmanschette. Obere Extremität 11, 228–238 (2016). https://doi.org/10.1007/s11678-016-0384-y

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  • DOI: https://doi.org/10.1007/s11678-016-0384-y

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