Therapie von Degenerationen und Verletzungen der Rotatorenmanschette

Abstract

The prevalence of rotator cuff lesions is age-dependent and up to 19-32 % for full-thickness ruptures and 13-32 % for partial-thickness lesions respectively. The therapy of partial-thickness ruptures should be considered in accordance with the articular, bursal or intratendinous location of the lesion. The therapy of full-thickness ruptures should be applied in accordance with topography and area of defect, retraction, atrophy and fatty infiltration. These parameters are considered to be important prognostic factors for the intraoperative repairability and the success of the surgery. Symptomatic or chronically progredient partial-thickness lesions as well as full-thickness lesions should generally be treated by means of surgical reconstruction. No current scientific consensus exists regarding improved clinical outcome data after the surgical approach in mini-open or arthroscopic technique. Both procedures should meet the requirements of the Gerber criteria for rotator cuff reconstruction: high primary stability, reduction of micro-movements, minimized approach associated morbidity and persisting stability to enable the fibroblastic tendon-to-bone healing. Current studies revealed a potential improvement of the tendon-to-bone healing by the application of several biologic augmentations. At the moment, these additive procedures can be applied in revision situations and for complex rotator cuff lesions with low tendon quality. No high-level in-vivo investigations concerning the human shoulder exist in the current literature that show evidence-based improvements by the additively applied biologic augmentations for rotator cuff repair.