Die arthroskopische subakromiale Dekompression hat die offene Akromioplastik stark in den Hintergrund gedrängt. Hingegen werden die meisten Rotatorenmanschettenrekonstruktionen offen oder „mini-open“ durchgeführt. Durch eine Verbesserung der arthroskopischen Techniken und Instrumentarien in den letzten Jahren ist es jedoch heute möglich, komplette Rotatorenmanschettenrupturen arthroskopisch zu operieren.

Although most subacromial decompressions are performed arthroscopically, rotator cuff repair is still performed using an open or mini-open procedure. Arthroscopic techniques have improved in the last decade, however, so that rotator cuff repair can also be performed arthroscopically. The potential complications of open repair are thus reduced and the superior functional results of cuff repair in comparison to débridement alone are maintained. The proposed advantages of the arthroscopic method are that it provides access to the glenohumeral joint for inspection and treatment of intra-articular lesions. The skin incisions are smaller, detachment of the deltoid muscle is not necessary, and there is less soft tissue dissection. By inspecting the bursal and articular side of the ruptured cuff, it is possible to measure the size of the tear and assess the quality of the tendon and whether it can be repaired. We present our arthroscopic technique of rotator cuff repair using bioabsorbable suture anchors and demonstrate our 1- to 6-years results with various suture anchors.

Zusammenfassung Während die arthroskopische subakromiale Dekompression die offene Akromioplastik stark in den Hintergrund gedrängt hat, werden die meisten Rotatorenmanschettenrekonstruktionen offen oder “mini-open” durchgeführt. Die arthroskopischen Operationstechniken haben sich aber in den letzten Jahren so sehr verbessert, dass heute komplette Rotatorenmanschettenrupturen arthroskopisch repariert werden können. Dadurch kann die potentielle Morbidität des offenen Vorgehens verringert werden bei verbesserten funktionellen Resultaten gegenüber dem alleinigen Débridement. Der Vorteil liegt dabei in der Möglichkeit, das Glenohumeralgelenk zu inspizieren und intraartikuläre Läsionen zu behandeln. Durch Betrachtung der artikulären und bursalen Seite der Rotatorenmanschette ist eine genaue Größenbestimmung des Risses, die Beurteilung der Sehnenqualität und die potentielle Refixationsmöglichkeit gegeben. Auf eine Ablösung des M. deltoideus kann verzichtet werden. Bei kleineren Inzisionen ist auch der Weichteilschaden durch das Operationstrauma geringer. Anhand des gegenwärtigen eigenen Vorgehens werden die arthroskopische Operationstechnik der Rotatorenmanschettenrekonstruktion unter Verwendung resorbierbarer Nahtanker und die Ergebnisse nach 1–6 Jahren mit verschiedenen Ankersystemen dargestellt.

The purpose of this paper is to report our experience with an arthroscopic stabilization technique using bone anchors in the treatment of chronic unidirectional anterior-inferior shoulder instability. 30 of 32 patients (average age, 26 years) were followed for an average of 24 months (range 12 to 36). There were 28 patients with dislocations and four with subluxations. In the group of the dislocators five patients had more than 10 dislocations and 15 patients between one and seven (average three). In 68% a sport injury was the reason for the first dislocation. Due to the length of the labroligamentous detachment two to four anchors were used for stabilization. According to the criteria of Rowe, in the group of the subluxators (4) two had an excellent and two a good result. In the group of the dislocators (26) two patients dislocated their shoulder again after reconstruction without a new accident, one had a recurrent dislocation from significant trauma. Two of them had an open stabilization afterwards. Overall there were 53.9% excellent, 34.6% good and 11.5% poor results. In 50% there was no restriction of shoulder motion, 21% had a loss of external rotation of 5o and 29% of 10o. Arthroscopic shoulder stabilization with help of Mitek anchors seems to be a good method for treatment of chronic unidirectional anterior-inferior instabilities with less than 10 dislocations preoperatively. All patients, who suffered a spontaneous recurrent dislocation, had more than 10 dislocations before. In these cases this arthroscopic procedure is not suited to restore stability, even if a Bankart-lesion is present.