Arthroskopische Rekonstruktion der Subscapularissehne

Obere Extremität 03/2011; 6(1):24-34. DOI: 10.1007/s11678-011-0104-6


Verletzungen der Subscapularissehne werden klinisch häufig übersehen. Relevante Rupturen haben allerdings eine erhebliche
und nicht kompensierbare Dezentrierung und Funktionseinschränkung der Schulter zu Folge. Spezifische klinische Tests und moderne
Schnittbildgebung führen zur Diagnose und präoperativen Klassifikation. Die Arthroskopie ermöglicht eine präzise Diagnostik
und Klassifikation der Sehnenläsionen, wobei neben der intraartikulären Beurteilung bei höhergradigen Rupturen auch eine extraartikuläre
Visualisierung der Subscapularissehne und der benachbarten Strukturen erforderlich ist. Die arthroskopische Rekonstruktion
von Subscapularissehnenrupturen setzt nicht nur ein präzises anatomisches Verständnis und fortgeschrittene arthroskopische
Fertigkeiten voraus, sondern sie erfordert neben der Technik der Refixation vor allem ein suffizientes Release der Sehnenstrukturen.
Angaben zu Resultaten nach arthroskopischer Refixation sind in der Literatur noch spärlich vorhanden. Unter Beachtung der
Klassifikation und der damit verbundenen Indikationsgrenzen lassen sich nach eigener Erfahrung gute Ergebnisse erzielen.

Lesions of the subscapularis tendon are often underdiagnosed in clinical practice. Relevant ruptures, however, lead to a decentering
of the humeral head followed by pain and loss of function. Specific clinical tests and the modern methods of imaging allow
for the correct diagnosis and preoperative classification. Arthroscopy permits the precise structural diagnosis of subscapularis
tendon lesions. Retracted lesions require an intraarticular as well as extraarticular visualization of the tendon and the
surrounding structures. The arthroscopic reconstruction of the subscapularis tendon requires not only are a profound understanding
of shoulder anatomy and advanced technical skills, but the fixation technique with sufficient release of the tendon is also
needed. There is still only little data in the literature on the outcome after arthroscopic reconstruction. However, using
the appropriate technique and respecting the limits of indication, good results can be attained.

SchlüsselwörterSehnenverletzungen–Ruptur–Arthroskopie–Schulter–Orthopädische Verfahren
KeywordsTendon injuries–Rupture–Arthroscopy–Shoulder–Orthopedic procedure

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    ABSTRACT: BACKGROUND: Subscapularis (SSC) tendon tears seem to regularly occur combined with lesions of the supraspinatus (SSP) and long biceps (LBS) tendons. The aim of this study was to evaluate the rupture configurations and results after arthroscopic treatment of anterosuperior rotator cuff tears. PATIENTS AND METHODS: A total of 65 consecutively treated patients [20 female, 45 male, median age 59 (23-80) years] with anterior and anterosuperior rotator cuff tears were examined prospectively. Rupture configurations were evaluated intraoperatively and subjective parameters, clinical function and Constant-Murley score (CMS) were assessed 12 months postoperatively. RESULTS: The SSC tears were isolated in 34 % and combined lesions of SSC and SSP were found in 66 % of patients. Additionally, LBS participation was observed in 65 % of patients and 12 (18%) patients had further concomitant lesions. Clinical function improved significantly and the age and gender-related CMS averaged 89.3 % 12 months postoperatively. Reconstructive treatment of concomitant lesions had a negative influence on outcome. Tenotomy of LBS led to better results than tenodesis. All patients would choose arthroscopic treatment again having knowledge of the postoperative result. CONCLUSION: Due to convincing short-term clinical results and advantages of minimally invasive surgery, arthroscopic treatment of anterior and anterosuperior rotator cuff tears has become prevalent. Treatment of concomitant LBS tendon pathology seems to play an important role in most patients. Further development of refixation techniques and better means of visualization will increase the trend towards arthroscopic treatment of anterosuperior rotator cuff tears in the future.
    Der Unfallchirurg 01/2013; 116(2). DOI:10.1007/s00113-012-2294-9 · 0.65 Impact Factor


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