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Scaffolds und biologische Optionen bei Revisionen einer Rotatorenmanschettenruptur

Supraspinatus- und Infraspinatussehne

Scaffolds and biological options for revisions of rotator cuff ruptures

Supraspinatus and infraspinatus tendons

  • Leitthema
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Arthroskopie Aims and scope

Zusammenfassung

Rotatorenmanschettenrerupturen stellen trotz fortgeschrittener arthroskopischer Technik und neuen Materialien nach wie vor ein Problem dar. Grund ist insbesondere die Narbengewebeheilung der Sehne am Knochen nach der Refixation. Neben dem technischen Fortschritt stellt die biologische Verbesserung der Sehnenheilung ein großes Ziel für die Zukunft dar. Hierfür gibt es 2 Ansätze: Einerseits wird der Rasen mit Wachstumsfaktoren, demineraliserter Knochenmatrix und Stammzellkonzentraten gedüngt, um so die Narbengewebeheilung zu einer physiologischeren Enthesenbildung anzuregen. Vieles ist in diesem Bereich allerdings noch experimentell; klinische Ergebnisse sind spärlich. Andererseits wird die Sehnen-Knochen-Naht-Konstruktion mit Patches verstärkt und damit entlastet, um eine bessere Einheilung zu ermöglichen. Klinische Ergebnisse hierzu sind vielversprechend. Das Endziel einer physiologischeren Sehnen-Knochen-Enthese bleibt derzeit allerdings noch in der Ferne, und verstärkte klinische Anwendungsbeobachtungen sind erforderlich.

Abstract

Despite advancements in arthroscopic techniques and materials, rotator cuff reruptures are still a problem. The main reason is that tendon-to-bone healing occurs resulting in scar tissue formation with diminished biological and biomechanical properties. Biological augmentation to create a more physiological enthesis is now the goal. Two options are available: firstly to “fertilize the lawn” with growth factors, demineralized bone matrix and stem cell concentrates in order to push the healing of scar tissue in the direction of a physiological enthesis formation. Experimental and animal studies show promising results; however, clinical results are still scarce. On the other hand, the tendon-bone-suture reconstruction can be reinforced with patches to promote a better tendon-to-bone healing. Although clinical results are also scarce the concept seems to be effective. The final goal of recreating a more physiological tendon-to-bone interface is still distant and more clinical studies are necessary.

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Authors and Affiliations

  1. Orthopädie II, Herz Jesu Krankenhaus, Baumgasse 20A, 1030, Wien, Österreich

    P. R. Heuberer &  W. Anderl

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Correspondence to P. R. Heuberer.

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Interessenkonflikt

P. R. Heuberer ist Berater bei Arthrex. Keine Arbeiten wurden von Arthrex finanziert. W. Anderl ist Berater bei Arthrex und erhält Royalties. Keine der diesem Artikel zugrundeliegenden Arbeiten wurde jedoch von Arthrex finanziert.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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Heuberer, P.R., Anderl, W. Scaffolds und biologische Optionen bei Revisionen einer Rotatorenmanschettenruptur. Arthroskopie 30, 241–245 (2017). https://doi.org/10.1007/s00142-017-0149-7

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