Arthroskopische Rekonstruktion der Subscapularissehne

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

ABSTRACT 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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