Evidenzbasierte Behandlung der kombinierten Rotatorenmanschetten- und SLAP-Läsion

 

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Zusammenfassung

Studienziel: Die Diagnose und Behandlung der SLAP-Läsion haben aufgrund verbesserter radiologischer und arthroskopischer Technik in letzter Zeit vermehrtes Interesse erfahren. Während man SLAP-Läsionen ursprünglich als (isolierte) Verletzung des Überkopfsportlers identifiziert hat, wurde rezent eine Assoziation der SLAP-Läsion mit Rotatorenmanschettendefekten in bis zu 40 % aller Fälle beschrieben. Diese Studie widmet sich der Frage der evidenzbasierten Behandlung dieser häufigen, kombinierten Läsionen. Methode: Basierend auf einem systematischen Review der Onlinedatenbanken PubMed, EMBASE, CINAHL und Cochrane Library identifizierten wir klinische Studien zur Behandlung von kombinierten SLAP-und Rotatorenmanschettenläsionen. Die Studienqualität wurde mittels Level of Evidence und einem modifizierten Jadad-Score gemessen. Klinische Ergebnisse waren Schulter-Scores und Bewegungsumfang. Ergebnisse: Sieben Studien mit 374 Patienten mit einem durchschnittlichen Alter von 53 ± 11 Jahren und 35 ± 13 Monaten Nachuntersuchungszeitraum wurden inkludiert. Kombinierte Läsionen haben einen signifikant negativen Effekt auf das Ergebnis isolierter Rotatorenmanschetten- oder SLAP-Nähte. Patienten älter als 45 Jahre hatten ein signifikant besseres klinisches Ergebnis nach Bizepssehnentenotomie als nach SLAP-Repair bei gleichzeitiger Rotatorenmanschettennaht. Bizepssehnentenotomie in Kombination mit Rotatorenmanschettennaht zeigten zudem statistisch signifikant bessere Bewegungsumfänge in Flexion und Rotation als SLAP-Repair plus Rotatorenmanschettennaht. Schlussfolgerung: In der Untersuchung und Aufklärung des Schulterpatienten sollte bedacht werden, dass SLAP- und Rotatorenmanschettenläsion häufig kombiniert vorliegen. Während bei jungen Patienten und bei der isolierten SLAP-Läsion exzellente klinische Ergebnisse nach Naht gesehen werden, sollten kombinierte Läsionen beim Patienten über 45 Jahre mit Bizepstenotomie bzw. Débridement plus Rotatorenmanschettennaht behandelt werden.

Abstract

Purpose: In the face of improved radiological and arthroscopic techniques the diagnosis and treatment of SLAP lesions has recently gained much interest. Originally described as an (isolated) injury of the overhead athlete, it was only recently that the association of SLAP and rotator cuff defects was described in up to 40 % of cases. This study addresses the question of the evidence-based treatment of such frequent, combined lesions. Methods: Based on a systematic review of the online databases PubMed, EMBASE, CINAHL and Cochrane Library we identified clinical studies on the treatment of combined SLAP and rotator cuff lesions. Study quality was assessed using levels of evidence and a modified Jadad score. Clinical outcome was assessed through scores and range of motion assessments. Results: We included 7 studies of 374 patients with a mean age of 53 ± 11 years followed for 35 ± 13 months. Combined lesions have a significant negative effect on isolated rotator cuff or SLAP repair. Patients older than 45 years of age had a significantly better clinical result after biceps tenotomy than SLAP repair with concomitant rotator cuff repair. Biceps tenotomy plus rotator cuff repair showed significantly better range of motion for flexion and rotation than SLAP plus rotator cuff repair. Conclusion: The frequent combination of SLAP and rotator cuff injury should be considered during assessment and informed consent of shoulder patients. While young patients and isolated SLAP lesions show excellent clinical results after elective repair, combined lesions should be treated with biceps tenotomy and/or debridement plus rotator cuff repair in patients older than 45 years.

^* Diese Autoren haben gleichermaßen zur Arbeit beigetragen.

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