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Arthritis und Rheuma 2016; 36(05): 325-329
DOI: 10.1055/s-0037-1617747
Schulterschmerz
Schattauer GmbH

Therapieoptionen bei primär nichtrekonstruierbaren Rotatorenmanschetten-Läsionen

Therapeutic options for primary non-reconstructable rotator cuff lesions
J. Kircher
1   Klinik Fleetinsel Hamburg, Schulter- und Ellenbogenchirurgie, Hamburg
3   Orthopädische Klinik, Universitätsklinikum, Medizinische Fakultät, Heinrich-Heine-Universität Düsseldorf, Düsseldorf
,
A. Hedtmann
1   Klinik Fleetinsel Hamburg, Schulter- und Ellenbogenchirurgie, Hamburg
,
A. Niemeier
2   Klinik und Poliklinik für Orthopädie, Universitätsklinikum Hamburg-Eppendorf, Hamburg
› Institutsangaben
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Publikationsverlauf

Publikationsdatum:
20. Dezember 2017 (online)

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Zusammenfassung

Rotatorenmanschetten-Läsionen sind häufige Erkrankungen mit einer altersabhängigen Zunahme in den entwickelten Ländern. Frühstadien und Partialläsionen zeigen sehr gute Langzeitresultate nach operativer Therapie. Verspätet erkannte Läsionen oder Re-Rupturen nach operativer Therapie sind oft nicht mehr rekonstruierbar und durch einen zentralen Sehnendefekt gekennzeichnet. Durch das oft höhere Lebensalter der Patienten in Kombination mit gestiegenen Ansprüchen stellt diese Patientenklientel eine besondere therapeutische Herausforderung dar. Sobald die Schulter einmal funktionell dekompensiert ist, bestehen kaum Chancen, durch konservative Therapie noch eine relevante Verbesserung zu erzielen. Es existieren daher verschiedene operative Ansätze, die Defekte funktionell zu kompensieren: die partielle Defektrekonstruktion unter Belassen partieller Defekte mit oder ohne Patch-Augmenta tion der Naht; Muskel-Sehnen-Schwenk- Operationen (Latissimus dorsi, Pectoralis major), der Einsatz von Defekt-überbrückenden Implantaten (künstliches oder allogenes Sehnenersatzmaterial), der Einsatz von Platzhaltern (subakromialer Ballon) bis hin zum endoprothetischen Schultergelenkersatz mittels inverser Endoprothese. Zuletzt wurde die Methode der sogenannten Superior Capsule Reconstruction popularisiert. Trotz einiger Fortschritte in vielen dieser Techniken sind die funktionellen Ergebnisse bei konservativer und operativer Therapie von primär nicht rekonstruierbaren Rupturen weiterhin der erfolgreichen Manschettenrekonstruktion unterlegen.

Summary

Rotator cuff lesions are a common disease with an age-dependent increase in the developed countries. Early stages of the disease and partial tears show excellent results after operative therapy. Advanced stages after delayed diagnosis and recurrence after surgical repair are characterized by a central tendon defect which often is not amenable to reconstruction. This patient group is a challenge to modern shoulder surgery due to the increasing life expectancy in combination with functional demands. Once functional decompensation is present the chances for relevant clinical improvement by conservative treatment are small. Several treatment options exist to achieve functional compensation: partial reconstruction with acceptance of small defects with or without patch augmentation; muscle tendon transfers (Latissimus dorsi, Pectoralis major); implantation of defect bridging materials (autologous or allogenic tendon replacement); implantation of spacers (subacromial balloon) and joint replacement by a reverse shoulder arthroplasty. Recently the method of superior capsule repair became popular. Despite a considerable progress in many of these techniques the functional results of operative and conservative therapy of primary non-reconstructable lesions are less favourable in comparison to a successful rotator cuff repair.

Schlüsselwörter

Schulter - Chirurgie - Sehne - autolog - Rotatorenmanschette - Patch-Augmentation - Transplantation

Keywords

Shoulder - surgery - tendon - autologous - rotator cuff - patch - transplantation
 

  • Literatur

  • 1 Milgrom C, Schaffler M, Gilbert S, van Holsbeeck M. Rotator-cuff changes in asymptomatic adults. The effect of age, hand dominance and gender. J Bone Joint Surg Br 1995; 77 (02) 296-298.
    Google Scholar
  • 2 Tempelhof S, Rupp S, Seil R. Age-related prevalence of rotator cuff tears in asymptomatic shoulders. J Shoulder Elbow Surg 1999; 08 (04) 296-299.
    CrossrefGoogle Scholar
  • 3 Yamaguchi K, Ditsios K, Middleton WD. et al. The demographic and morphological features of rotator cuff disease. A comparison of asymptomatic and symptomatic shoulders. J Bone Joint Surg Am 2006; 88 (08) 1699-1704.
    CrossrefGoogle Scholar
  • 4 Moosmayer S, Smith HJ, Tariq R, Larmo A. Prevalence and characteristics of asymptomatic tears of the rotator cuff: an ultrasonographic and clinical study. J Bone Joint Surg Br 2009; 91 (02) 196-200.
    Google Scholar
  • 5 Yamamoto A, Takagishi K, Osawa T. et al. Prevalence and risk factors of a rotator cuff tear in the general population. J Shoulder Elbow Surg 2010; 19 (01) 116-120.
    Google Scholar
  • 6 Plate JF, Bates CM, Mannava S. et al. Age-related degenerative functional, radiographic, and histological changes of the shoulder in nonhuman primates. Journal of Shoulder and Elbow Surgery 2013; 22 (08) 1019-1029.
    CrossrefGoogle Scholar
  • 7 Shindle MK, Chen CC, Robertson C. et al. Full-thickness supraspinatus tears are associated with more synovial inflammation and tissue degeneration than partial-thickness tears. J Shoulder Elbow Surg 2011; 20 (06) 917-927.
    CrossrefPubMedGoogle Scholar
  • 8 Robertson CM, Chen CT, Shindle MK. et al. Failed healing of rotator cuff repair correlates with altered collagenase and gelatinase in supraspinatus and subscapularis tendons. Am J Sports Med 2012; 40 (09) 1993-2001.
    CrossrefPubMedGoogle Scholar
  • 9 Neer 2nd CS. Anterior acromioplasty for the chronic impingement syndrome in the shoulder: a preliminary report. J Bone Joint Surg Am 1972; 54 (01) 41-50.
    CrossrefGoogle Scholar
  • 10 Neer 2nd CS. Impingement lesions. Clin Orthop Relat Res 1983; 173: 70-77.
    Google Scholar
  • 11 Bigliani LU, Ticker JB, Flatow EL. et al. The relationship of acromial architecture to rotator cuff disease. Clin Sports Med 1991; 10 (04) 823-838.
    Google Scholar
  • 12 Keener JD, Galatz LM, Teefey SA. et al. A prospective evaluation of survivorship of asymptomatic degenerative rotator cuff tears. J Bone Joint Surg Am 2015; 97 (02) 89-98.
    CrossrefGoogle Scholar
  • 13 Keener JD, Hsu JE, Steger-May K. et al. Patterns of tear progression for asymptomatic degenerative rotator cuff tears. J Shoulder Elbow Surg 2015; 24 (12) 1845-1851.
    CrossrefGoogle Scholar
  • 14 Thomazeau H, Rolland Y, Lucas C. et al. Atrophy of the supraspinatus belly. Assessment by MRI in 55 patients with rotator cuff pathology. Acta Orthop Scand 1996; 67 (03) 264-268.
    CrossrefPubMedGoogle Scholar
  • 15 Zanetti M, Gerber C, Hodler J. Quantitative assessment of the muscles of the rotator cuff with magnetic resonance imaging. Invest Radiol 1998; 33 (03) 163-170.
    CrossrefGoogle Scholar
  • 16 Goutallier D, Postel JM, Bernageau J. et al. Fatty muscle degeneration in cuff ruptures. Pre- and postoperative evaluation by CT scan. Clin Orthop Relat Res 1994; 304: 78-83.
    CrossrefGoogle Scholar
  • 17 Fuchs B, Weishaupt D, Zanetti M. et al. Fatty degeneration of the muscles of the rotator cuff: assessment by computed tomography versus magnetic resonance imaging. J Shoulder Elbow Surg 1999; 08 (06) 599-605.
    CrossrefGoogle Scholar
  • 18 Cofield RH, Parvizi J, Hoffmeyer PJ. et al. Surgical repair of chronic rotator cuff tears. A prospective longterm study. J Bone Joint Surg Am 2001; 83-A-1: 71-77.
    Google Scholar
  • 19 Patte D. Classification of rotator cuff lesions. Clin Orthop Relat Res 1990; 254: 81-86.
    CrossrefGoogle Scholar
  • 20 Burkhart SS. The principle of margin convergence in rotator cuff repair as a means of strain reduction at the tear margin. Ann Biomed Eng 2004; 32 (01) 166-170.
    CrossrefGoogle Scholar
  • 21 Lo IK, Burkhart SS. The interval slide in continuity: a method of mobilizing the anterosuperior rotator cuff without disrupting the tear margins. Arthroscopy 2004; 20 (04) 435-441.
    CrossrefGoogle Scholar
  • 22 Gerber C, Vinh TS, Hertel R, Hess CW. Latissimus dorsi transfer for the treatment of massive tears of the rotator cuff. A preliminary report. Clin Orthop Relat Res 1988; 232: 51-61.
    Google Scholar
  • 23 Gerber C, Rahm SA, Catanzaro S. et al. Latissimus dorsi tendon transfer for treatment of irreparable posterosuperior rotator cuff tears: long-term results at a minimum follow-up of ten years. J Bone Joint Surg Am 2013; 95 (21) 1920-1926.
    CrossrefGoogle Scholar
  • 24 Herzberg G, Urien JP, Dimnet J. Potential excursion and relative tension of muscles in the shoulder girdle: relevance to tendon transfers. J Shoulder Elbow Surg 1999; 08 (05) 430-437.
    CrossrefGoogle Scholar
  • 25 Habermeyer P, Magosch P, Rudolph T. et al. Transfer of the tendon of latissimus dorsi for the treatment of massive tears of the rotator cuff: a new single-incision technique. J Bone Joint Surg Br 2006; 88 (02) 208-212.
    PubMedGoogle Scholar
  • 26 Gervasi E, Causero A, Parodi PC. et al. Arthroscopic latissimus dorsi transfer. Arthroscopy 2007; 23 (11) 1243 e1–4.
    Google Scholar
  • 27 Irlenbusch U, Bracht M, Gansen HK. et al. Latissimus dorsi transfer for irreparable rotator cuff tears: a longitudinal study. J Shoulder Elbow Surg 2008; 17 (04) 527-534.
    CrossrefPubMedGoogle Scholar
  • 28 El-Azab HM, Rott O, Irlenbusch U. Long-term follow-up after latissimus dorsi transfer for irreparable posterosuperior rotator cuff tears. J Bone Joint Surg Am 2015; 97 (06) 462-469.
    CrossrefGoogle Scholar
  • 29 El-Azab HM, Rott O, Irlenbusch U. Long-Term Follow-up After Latissimus Dorsi Transfer for Irreparable Posterosuperior Rotator Cuff Tears. The Journal of Bone & Joint Surgery 2015; 97 (06) 462-469.
    CrossrefGoogle Scholar
  • 30 Habermeyer P, Magosch P, Rudolph T. et al. Transfer of the tendon of latissimus dorsi for the treatment of massive tears of the rotator cuff. A new single-incision technique. J Bone Joint Surg Br 2006; 88 (02) 208-212.
    PubMedGoogle Scholar
  • 31 Werner CM, Zingg PO, Lie D. et al. The biomechanical role of the subscapularis in latissimus dorsi transfer for the treatment of irreparable rotator cuff tears. J Shoulder Elbow Surg 2006; 15 (06) 736-742.
    CrossrefPubMedGoogle Scholar
  • 32 Costouros JG, Espinosa N, Schmid MR, Gerber C. Teres minor integrity predicts outcome of latissimus dorsi tendon transfer for irreparable rotator cuff tears. J Shoulder Elbow Surg 2007; 16 (06) 727-734.
    CrossrefPubMedGoogle Scholar
  • 33 Espinosa-Uribe AG, Negreros-Osuna AA, Gutierrézde la JO. et al. An age- and gender-related three-dimensional analysis of rotator cuff transverse force couple volume ratio in 304 shoulders. Surgical and Radiologic Anatomy 2016; 1-8.
    Google Scholar
  • 34 Wirth MA, Rockwood Jr CA. Operative treatment of irreparable rupture of the subscapularis. J Bone Joint Surg Am 1997; 79 (05) 722-731.
    CrossrefGoogle Scholar
  • 35 Resch H, Povacz P, Ritter E, Matschi W. Transfer of the pectoralis major muscle for the treatment of irreparable rupture of the subscapularis tendon. J Bone Joint Surg Am 2000; 82 (03) 372-382.
    CrossrefGoogle Scholar
  • 36 Gavriilidis I, Kircher J, Magosch P. et al. Pectoralis major transfer for the treatment of irreparable anterosuperior rotator cuff tears. Int Orthop 2010; 34 (05) 689-694.
    CrossrefGoogle Scholar
  • 37 Neviaser JS, Neviaser RJ, Neviaser TJ. The repair of chronic massive ruptures of the rotator cuff of the shoulder by use of a freeze-dried rotator cuff. J Bone Joint Surg Am 1978; 60 (05) 681-684.
    CrossrefGoogle Scholar
  • 38 Bond JL, Dopirak RM, Higgins J. et al. Arthroscopic replacement of massive, irreparable rotator cuff tears using a GraftJacket allograft: technique and preliminary results. Arthroscopy. 2008; 24 (04) 403-409 e1.
    Google Scholar
  • 39 Wong I, Burns J, Snyder S. Arthroscopic GraftJacket repair of rotator cuff tears. J Shoulder Elbow Surg 2010; 19 (Suppl. 02) 104-109.
    CrossrefGoogle Scholar
  • 40 Gupta AK, Hug K, Boggess B. et al. Massive or 2-tendon rotator cuff tears in active patients with minimal glenohumeral arthritis: clinical and radiographic outcomes of reconstruction using dermal tissue matrix xenograft. Am J Sports Med 2013; 41 (04) 872-879.
    CrossrefGoogle Scholar
  • 41 Mori D, Funakoshi N, Yamashita F. Arthroscopic surgery of irreparable large or massive rotator cuff tears with low-grade fatty degeneration of the infraspinatus: patch autograft procedure versus partial repair procedure. Arthroscopy 2013; 29 (12) 1911-1921.
    Google Scholar
  • 42 Encalada-Diaz I, Cole BJ, Macgillivray JD. et al. Rotator cuff repair augmentation using a novel polycarbonate polyurethane patch: preliminary results at 12 months’ follow-up. J Shoulder Elbow Surg 2011; 20 (05) 788-794.
    CrossrefGoogle Scholar
  • 43 Barber FA, Burns JP, Deutsch A. et al. A prospective, randomized evaluation of acellular human dermal matrix augmentation for arthroscopic rotator cuff repair. Arthroscopy 2012; 28 (01) 8-15.
    CrossrefGoogle Scholar
  • 44 Ciampi P, Scotti C, Nonis A. et al. The benefit of synthetic versus biological patch augmentation in the repair of posterosuperior massive rotator cuff tears: a 3-year follow-up study. Am J Sports Med 2014; 42 (05) 1169-1175.
    CrossrefGoogle Scholar
  • 45 Giannotti S, Ghilardi M, Dell’osso G. et al. Study of the porcine dermal collagen repair patch in morphofunctional recovery of the rotator cuff after minimum follow-up of 2.5 years. Surg Technol Int 2014; 24: 348-352.
    Google Scholar
  • 46 Proctor CS. Long-term successful arthroscopic repair of large and massive rotator cuff tears with a functional and degradable reinforcement device. J Shoulder Elbow Surg 2014; 23 (10) 1508-1513.
    CrossrefGoogle Scholar
  • 47 Steinhaus ME, Makhni EC, Cole BJ. et al. Outcomes After Patch Use in Rotator Cuff Repair. Arthroscopy 2016; 32: 1676-1690.
    CrossrefGoogle Scholar
  • 48 Iannotti JP, Codsi MJ, Kwon YW. et al. Porcine small intestine submucosa augmentation of surgical repair of chronic two-tendon rotator cuff tears. A randomized, controlled trial. J Bone Joint Surg Am 2006; 88 (06) 1238-1244.
    CrossrefGoogle Scholar
  • 49 Walton JR, Bowman NK, Khatib Y. et al. Restore orthobiologic implant: not recommended for augmentation of rotator cuff repairs. J Bone Joint Surg Am 2007; 89 (04) 786-791.
    Google Scholar
  • 50 Ricchetti ET, Aurora A, Iannotti JP, Derwin KA. Scaffold devices for rotator cuff repair. Journal of Shoulder and Elbow Surgery 2012; 21 (02) 251-265.
    CrossrefGoogle Scholar
  • 51 Bateman JE. The diagnosis and the treatment of ruptures of the rotator cuff. Surg Clin North Am 1963; 43: 1523-1530.
    CrossrefGoogle Scholar
  • 52 Butler DL, Grood ES, Noyes FR. et al. Effects of structure and strain measurement technique on the material properties of young human tendons and fascia. J Biomech 1984; 17 (08) 579-596.
    CrossrefGoogle Scholar
  • 53 Aurora A, Mesiha M, Tan CD. et al. Mechanical characterization and biocompatibility of a novel reinforced fascia patch for rotator cuff repair. J Biomed Mater Res A 2011; 99 (02) 221-230.
    Google Scholar
  • 54 Kircher J, Schmidt F, Hedtmann A. et al. Can a biologic augmentation of rotator cuff tendon defects be produced using autologeous hamstring tendons?. A biomechanical feasibility study. Annual congress of the European Society for Surgery of the Shoulder and the Elbow. Milan. 2015: 15-2281.
    Google Scholar
  • 55 Kircher J, Schmidt F, Hedtmann A. et al. Biomechanische Testung eines autologen Sehnenersatz-Patches (Hamstringsehnengeflecht) zur Behandlung von irreparablen Rotatorenmanschetten-Läsionen mit Sehnendefekt. Jahreskongress der Deutschen Vereinigung für Schulter- und Ellenbogenchirurgie. Bremen 2016; S22-S182.
    Google Scholar
  • 56 Neer 2nd CS, Craig EV, Fukuda H. Cuff-tear arthropathy. J Bone Joint Surg Am 1983; 65 (09) 1232-1244.
    CrossrefGoogle Scholar
  • 57 Mihata T, Lee TQ, Watanabe C. et al. Clinical Results of Arthroscopic Superior Capsule Reconstruction for Irreparable Rotator Cuff Tears. Arthroscopy 2013; 29 (03) 459-470.
    CrossrefGoogle Scholar
  • 58 Mihata T, McGarry MH, Kahn T. et al. Biomechanical Effect of Thickness and Tension of Fascia Lata Graft on Glenohumeral Stability for Superior Capsule Reconstruction in Irreparable Supraspinatus Tears. Arthroscopy 2016; 32 (03) 418-426.
    CrossrefPubMedGoogle Scholar
  • 59 Tokish JM, Beicker C. Superior Capsule Reconstruction Technique Using an Acellular Dermal Allograft. Arthrosc Tech 2015; 4–6: e833-e839.
    Google Scholar
  • 60 Senekovic V, Poberaj B, Kovacic L. et al. Prospective clinical study of a novel biodegradable sub-acromial spacer in treatment of massive irreparable rotator cuff tears. European Journal of Orthopaedic Surgery & Traumatology 2013; 23 (03) 311-316.
    Google Scholar
  • 61 Boileau P, Gonzalez JF, Chuinard C. et al. Reverse total shoulder arthroplasty after failed rotator cuff surgery. Journal of Shoulder and Elbow Surgery 2009; 18 (04) 600-606.
    CrossrefGoogle Scholar
  • 62 Mulieri P, Dunning P, Klein S. et al. Reverse shoulder arthroplasty for the treatment of irreparable rotator cuff tear without glenohumeral arthritis. Journal of Bone and Joint Surgery – Series A 2010; 92 (15) 2544-2556.
    Google Scholar
  • 63 Hartzler RU, Steen BM, Hussey MM. et al. Reverse shoulder arthroplasty for massive rotator cuff tear: risk factors for poor functional improvement. Journal of Shoulder and Elbow Surgery 2015; 24 (11) 1698-1706.
    CrossrefGoogle Scholar
  • 64 Bigliani LU, Cordasco FA, McLlveen SJ, Musso ES. Operative repair of massive rotator cuff tears: Longterm results. J Shoulder Elbow Surg 1992; 01 (03) 120-130.
    CrossrefGoogle Scholar
  • 65 Gerber C, Fuchs B, Hodler J. The results of repair of massive tears of the rotator cuff. J Bone Joint Surg Am 2000; 82 (04) 505-515.
    CrossrefPubMedGoogle Scholar
  • 66 Galatz LM, Ball CM, Teefey SA. et al. The outcome and repair integrity of completely arthroscopically repaired large and massive rotator cuff tears. J Bone Joint Surg Am 2004; 86-A-2: 219-224.
    Google Scholar
  • 67 Bishop J, Klepps S, Lo IK. et al. Cuff integrity after arthroscopic versus open rotator cuff repair: a prospective study. J Shoulder Elbow Surg 2006; 15 (03) 290-299.
    CrossrefGoogle Scholar
  • 68 Zumstein MA, Jost B, Hempel J. et al. The clinical and structural long-term results of open repair of massive tears of the rotator cuff. J Bone Joint Surg Am 2008; 90 (11) 2423-2431.
    CrossrefGoogle Scholar
  • 69 Hanusch BC, Goodchild L, Finn P, Rangan A. Large and massive tears of the rotator cuff: functional outcome and integrity of the repair after a mini-open procedure. J Bone Joint Surg Br 2009; 91 (02) 201-205.
    CrossrefPubMedGoogle Scholar
  • 70 Yamaguchi H, Suenaga N, Oizumi N. et al. Open repair for massive rotator cuff tear with a modified transosseous-equivalent procedure: preliminary results at short-term follow-up. J Orthop Sci 2011; 16 (04) 398-404.
    CrossrefGoogle Scholar
  • 71 Papadopoulos P, Karataglis D, Boutsiadis A. et al. Functional outcome and structural integrity following mini-open repair of large and massive rotator cuff tears: a 3–5 year follow-up study. J Shoulder Elbow Surg 2011; 20 (01) 131-137.
    CrossrefGoogle Scholar
  • 72 Kim JR, Cho YS, Ryu KJ, Kim JH. Clinical and radiographic outcomes after arthroscopic repair of massive rotator cuff tears using a suture bridge technique: assessment of repair integrity on magnetic resonance imaging. Am J Sports Med 2012; 40 (04) 786-793.
    CrossrefGoogle Scholar
  • 73 Chung SW, Kim JY, Kim MH. et al. Arthroscopic repair of massive rotator cuff tears: outcome and analysis of factors associated with healing failure or poor postoperative function. Am J Sports Med 2013; 41 (07) 1674-1683.
    CrossrefPubMedGoogle Scholar