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Rezidivinstabilität nach Voroperation

Recurrent instability after previous operation

  • Leitthema
  • Published:
Arthroskopie Aims and scope

Zusammenfassung

Einleitung

Das Auftreten einer erneuten Luxation nach Schulterstabilisierung kann verschiedene Ursachen haben. Patientenspezifische Faktoren, das Auftreten erneuter Traumen sowie Voroperationen spielen hierbei eine Rolle.

Methoden

Die exakte Analyse der zugrunde liegenden Pathologie erfolgt anhand einer klinischen Untersuchung sowie verschiedener Bildgebungsverfahren, wie Röntgen, Magnetresonanztomographie (MRT) und Computertomographie (CT). Bei der Planung der Revisionsoperation stehen eine arthroskopische/offene Weichteilstabilisierung (Bankart-Operation) und ein Knochenblockverfahren (Beckenkammspan oder Korakoidtransfer nach Latarjet) zur Verfügung.

Ergebnisse

In den meisten Fällen liegen kombinierte Pathologien aus Pfannenranddefekt und komplexem Weichteilschaden an Kapsel und Labrum vor. Die Durchführung der Kapsel-Labrum-Rekonstruktion im Revisionsfall erfordert eine sehr sorgfältige Operationstechnik und sollte von einem erfahrenen Experten durchgeführt werden. Die Indikation für eine Weichteilstabilisierung ergibt sich, wenn prä- oder intraoperativ eine rekonstruierbare Weichteilläsion, aber kein Pfannenranddefekt vorliegt, was nur selten der Fall ist. Bei einer Konstellation aus komplexer Weichteil-Knochen-Pathologie und Glenoidrandknochendefekt ist eine Bankart-Operation kontraindiziert. Die Indikation für ein Knochenblockaugmentationsverfahren des Glenoids ergibt sich aus dem regelhaften Knochendefekt am vorderen Glenoidrand. Insbesondere für die Rezidivinstabilität nach Voroperation stellt die arthroskopische Latarjet-Operation auf Grund des Sling- oder Belt-Effekts ein ideales Revisionsverfahren dar.

Schlussfolgerung

Die Fallzahlen für Revisionseingriffe bei Schulterinstabilität werden voraussichtlich in den nächsten Jahren ansteigen. Aus diesem Grund muss vorab eine gründliche und individuell auf den Patienten abgestimmte Planung der Revisionsoperation erfolgen.

Abstract

Introduction

The occurrence of renewed dislocation after shoulder stabilization can be due to a variety of reasons. Patient-specific factors, reoccurrence of trauma and previous operations can all play a role here.

Methods

The exact analysis of the underlying pathology is carried out by a clinical examination and a variety of imaging procedures, such as X-ray imaging, magnetic resonance imaging (MRI) and computed tomography (CT). When planning the revision surgery various procedures, such as arthroscopic open soft tissue stabilization (Bankart repair) and bone block procedures (iliac crest or coracoid transfer according to Latarjet) are available.

Results

In most cases a combination of pathologies due to glenoid rim defects and complex soft tissue damage on the capsule and labrum are involved. The capsulo-labrum reconstruction in revision cases requires a very detailed operation technique and should be carried out by experienced experts. The indications for soft tissue stabilization are given if a reconstructable soft tissue lesion is present preoperatively or postoperatively but no glenoid rim defect, which is only rarely the case. In constellations consisting of complex soft tissue and bone pathologies and glenoid rim bony defects, a Bankart operation is contraindicated. The indications for a bone block augmentation procedure of the glenoid are given in case of a bone defect of the anterior glenoid rim. The arthroscopic Latarjet operation represents an ideal revision procedure due to the sling effect, especially for recurrent instability after a previous operation.

Conclusion

The number of cases of revision interventions for shoulder instability is expected to increase in the coming years. For this reason a thorough and patient-specific individualized planning of the revision operation must be carried out in advance.

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Authors and Affiliations

  1. go:H Gelenkchirurgie Orthopädie Hannover, Uhlemeyerstr. 16, 30175, Hannover, Deutschland

    J. D. Agneskirchner

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Correspondence to J. D. Agneskirchner.

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J. D. Agneskirchner gibt an, dass kein Interessenkonflikt besteht.

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M. Flury, Zürich

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Agneskirchner, J.D. Rezidivinstabilität nach Voroperation. Arthroskopie 28, 281–291 (2015). https://doi.org/10.1007/s00142-015-0044-z

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