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P Habermeyer

Publications and source records attributed to P Habermeyer.

At least 37 records · Page 2Linked to original sources
PubMed2002

[Arthroscopic treatment of shoulder instability].

Arthroscopic treatment of glenohumeral instability has become more common over the last years. Compared with open reconstruction which still is the gold standard in the treatment of glenohumeral instability the arthroscopic techniques show several advantages but also disadvantages that must be proved for every single case. Careful patient selection with regard of prognostic preoperative and intraoperative factors is substantial for successful treatment. When indicated using clinical, radiological and arthroscopic findings the results of arthroscopic stabilization could be improved over the last years and failure rates could be decreased.

Arthroscopy↗
PubMed2002

[Physical activity after shoulder arthroplasty].

A hemi- or total shoulder arthroplasty was performed in 171 patients between 1992 and 1997. We examined 118 patients under the age of 70 regarding their level of physical activity. For a pre- and postoperative comparison we divided the patients in two groups. Group one included all patients with osteoarthritis, rheumatoid arthritis, instability associated arthritis, avascular necrosis and other arthropathies. Group two included acute fractures and fracture sequelae. The postoperative outcome was functionally assessed by using the Constant score. There was an average Constant score of 60,9 for group one and 67,1 for group two. Both groups showed a domination of activities with motion patterns unspecific for the shoulder. There were more patients in group two reporting activities which depend on a good or very good shoulder function. There is no general estimation for the ability to be active in sports after shoulder arthroplasty. An individual assessment of the shoulder function is essential. Important criterias beside motivation and age are the status of the rotator cuff and the soft tissue balancing. The correct indication for shoulder arthroplasty as well as the preoperative planning and the postoperative rehabilitation program are essential for a good functional outcome and the key for physical activity after shoulder arthroplasty.

Adult↗
PubMed2000

[Recommendations for diagnosis and expert assessment of traumatic rotator cuff lesions].

Traumatic rotator cuff lesions are a very rare condition. However, this article represents a comprehensive survey according to current knowledge on anatomy, biomechanics, and pathogenesis of rotator cuff pathology. Because of the relatively high prevalence of degenerative changes with increasing age, including partial and complete rotator cuff tears, it may be difficult to demonstrate the causality of an acute traumatic rotator cuff tear. Therefore, a catalogue of potential adequate and inadequate trauma mechanisms is proposed. Emphasis is also placed on posttraumatic diagnostic steps following persistent rotator cuff deficient shoulder function (e.g., ultrasound, MRI). From a legal aspect (e.g., private accident insurance, workers compensation claim), different minor and major criteria are defined, which could help experts to judge the causality of posttraumatic rotator cuff deficiency. These criteria mainly refer to distinct details concerning patients' history, trauma mechanism, primary clinical appearance, and diagnostic findings.

Diagnosis, Differential↗
PubMed2000

[The macroscopic aspect of rotator cuff tears in traumatic and nontraumatic rupture cases].

The decision whether a rotator cuff tear has a traumatic or degenerative origin still causes some controversy. Especially in medical expert appraisals the etiology of the rotator cuff tear plays an important role referring to insurance services for the patient. The purpose of this paper is to compare the intraoperative pathomorphologic shape of the cuff tear in traumatic and degenerative cases. This study reports of 56 patients with rotator cuff tears which were divided in primarily acute, subacute traumatic and degenerative study groups referring to their history of present illness. We considered the location of the tear, the shape and the size. Furthermore the grade of retraction of the supraspinatus tendon, its quality and the shape of the long head of biceps were examined. The results showed that in general the shape of the tear gives only in some cases significant information whether the etiology is traumatic or not. The isolated rupture of the subscapularis muscle and the hematoma at the edge of the tendon is significant for the trauma. In comparison with the degenerative study group the tenosynovitis and the dislocation of the long head of biceps is in our study significant for traumatic tears.

Diagnosis, Differential↗
PubMed2000

[Rotator cuff tears: diagnosis and therapy].

Since the life span of our society is increasing and the expectation of high functional demands is growing more and more older people take part in sports activities emphasises the necessity of early diagnosis of rotator cuff lesions and their correct treatment. The goal of any diagnostic means should be a proper treatment of rotator cuff lesions according to the detected pathology. New arthroscopic techniques to surgically reconstruct rotator cuff tears have brought the operative repair techniques another step further. In cases of large and complex cuff tears the surgeon can individually select an adequate reconstruction procedure which includes anatomical-, partial-, tendon-transfer and muscle-transfer repairs. In cases of irreparable tears with cuff-tear arthropathy and consecutive superior migration of the humeral head hemiarthroplasty or the inverse deltoid prosthesis have to be considered. Based on clinical, radiological and arthroscopic findings we developed algorithms that will lead to the best suited procedure for a given lesion.

Algorithms↗
PubMed1999

[Current status and perspectives of shoulder replacement].

Basis of the modern shoulder implants is the Neer II-system, a non constrained total shoulder prosthesis with conforming radii of curvature and improved protection against dislocation. The second generation of shoulder prosthesis is based on the geometric shaft design of the Neer II prosthesis and offers not only a variety of modular head- and shaft-sizes but also through different radii a physiologic rotation-translation-mechanism. The third generation of humeral head prosthesis carries the concept of an anatomic reconstruction one step further and enables the surgeon to adjust the inclination and the eccentric offset of the humeral head to restore the centre of rotation. The latest development in shoulder arthroplasty are humeral head prosthesis with a fully variable 3-dimensional modularity to independently adjust the prosthetic head position regardless of the individual shaft geometry. This achieves a 3-dimensional adaptability of the prosthetic head about the stem axis in the coronary and in the sagittal plane. Besides of the humeral shaft prosthesis an alternative concept of shoulder joint replacement is established - the replacement of the humeral head articular surface. A hemispheric surface prosthesis - cup arthroplasty - is cemented onto the residual humeral head, which eliminates the obligatory humeral head resection and the reaming of the medullary canal. Bipolar shoulder prosthesis are humeral shaft prosthesis with a bi-rotational head system. Their indication is limited to pre-existing lesions of the rotator cuff and/or the glenoid surface. The inverse total shoulder prosthesis reverses the articular surface morphology of the humeral head and the glenoid. The hemispheric glenoid component serves as the centre of rotation for the concave epiphyseal proximal humerus component. This implant is especially used in cases of massive rotator cuff deficiencies. The role of shoulder prosthesis in treating acute humeral head fractures needs special consideration. A fracture prosthesis has to restore the exact length of the humerus, the centre of rotation, and the anatomical retroversion. Positioning of the tubercula and their adequate osteosynthesis is most critical and fundamental to ensure a correct healing process. A failed consolidation of the tubercula does not lead to a satisfying result. The shoulder joint replacement can be sufficiently fixated in cemented, cementless or hybrid techniques. Today several component design variations of cemented glenoid implants exist. Their main distinction is the fixation system which can be divided into two main groups - the keel - and the peg-shaped glenoid components. The peg-shaped anchorage system shall guarantee a greater stability against shear-forces. Cementless glenoid components consist of a polyethylene inlay and a surface treated metal-back with an integrated fixation system. These fixation systems are object of intensive biomechanical research and range from conventional screw fixation to specialised cone systems and self-cutting cage-screw-systems. The critical area of cementless glenoid components is the transition zone of the PE-inlay and the metal-back because of high force development. The question of implanting a hemi- or total shoulder prosthesis is answered by the morphologic changes of the glenoid articular surface, which includes the size of the subchondral defect and the underlying etiology of the shoulder joint disease, and the age of the patient. Preoperative planning must consist of an adequate radiologic work-up - X-ray, CT or MRI - to accurately assess the glenoid morphology. G. Walch categorised the different glenoid lesions and developed a very important classification of possible glenoid deformations. To compare and evaluate the operative results one must consider the different shoulder prosthesis and the discrepancies between a hemi- and a total shoulder prosthetic replacement. Looking at the loosening and survival rate of the implant the results are

Equipment Failure Analysis↗
PubMed1998

[Treatment strategy in first traumatic anterior dislocation of the shoulder. Plea for a multi-stage concept of preventive initial management].

The purpose of this paper is to outline the treatment protocol for the first time traumatic anterior shoulder dislocator, with options including conservative, arthroscopic and open surgical treatment. Regarding the subclassification of the first time traumatic anterior dislocater, it is imparitive to differentiate between the unidirectional dislocator with and without hyperlaxity. This subclassification takes into account the structural quality of the stabilizing ligamentous structures of the glenohumeral capsule. The patient with hyperelastic ligaments exhibit elastic deformation of the glenohumeral ligaments at the time of dislocation and thus, sustain less interstitial structural damage to the ligament. Therefore, these patients benefit from non-operative treatment. There are extrinsic and intrinsic factors which determine the outcome of the primary traumatic anterior shoulder dislocation. Extrinsic factors are those that are not related to changes in the shoulder morphology. The most important extrinsic factor is the age of the patient at the time of injury. The younger the patient at the time of injury the greater the risk of recurrence. As a rule, those patients 25 years of age or less, at the time of initial injury are less likely to spontaneously stabilize without surgical intervention, than they are to develop recurrence. Secondly, the type and level of sport participation is related to recurrence. Although the severity of the trauma can not be quantified, it certainly has an influence on recurrence. Immobilization remains controversial. A rehabilitation program is more likely to be successful in atraumatic instability. Patient compliance is important regardless of the type of treatment selected. Intrinsic factors include injury to the various anatomic structures about the shoulder, occurring at the time of primary anterior shoulder dislocation. A deep Hill Sachs lesion is more likely to result in recurrence secondary to both the impaction of the bone, as well as, the reduction of the area of articular surface. A displaced bony Bankart is a highly unstable situation secondary to the loss of the butress to retain the humeral head. In contrast to a Hill Sachs lesion or a bony Bankart, a concomittent fracture of the greater tuberosity is unlikely to result in recurrent dislocation. Isolated laberal detachment is not related to recurrence, but a complete disruption of the laberal ligament complex is highly correlated with recurrence. A rare subluxation erecta, as a special form of traumatic inferior instability, has a high recurrence rate. With increasing age there is a higher risk of concomittent rotator cuff tear. In most situations surgical repair of the rotator cuff tear results in resolution of the instability. The essential issue in determining the treatment protocol is to define concomittent hyperlaxity in the injured shoulder. Concomittent hyperlaxity precludes initial surgical treatment. The orthopedic surgeon treating the patient at the time of injury needs to design a concise treatment protocol for the patient based on the assessment of the extrinsic and intrinsic factors. An unreducable shoulder dislocation or associated vascular injury requires emergent intervention. Absolute indications for surgical treatment include: persistent dislocation, bony Bankart, a grossly displaced greater tuberosity fracture, and rupture of the subscapularis tendon. Surgical stabilization of primary anterior traumatic dislocation is indicated if the following strict criteria are met: adequate trauma, no self reduction, unidirectional instability without hyperlaxity, Hill Sachs lesion, age below 26 years, high level of sport activity and the special situation of luxatio erecta. Post primary stabilization is indicated for persistent subluxation, subjective instability or demonstrated pathologic instability tests. Rotator cuff tears due to traumatic dislocation in the elderly population require surgical repair.

Arthroscopy↗
PubMed1998

[Current status of shoulder arthroscopy].

Arthroscopic and open shoulder surgery have to be combined for a successful surgical therapy of the shoulder joint. A surgeon performing open surgery only or just treating by arthroscopic measurements can not cover the full spectrum of modern shoulder surgery. Isolated diagnostic arthroscopy is rarely indicated. Far more common, diagnostic arthroscopy is combined with an operative procedure both to confirm preoperative assessment of pathology and to uncover associated lesions. The results of arthroscopic stabilisation of chronic anterior posttraumatic dislocations fail to compare with high success rates of open procedures. Better patient selection will probably be the key to improving results. In case of acute traumatic first time dislocation in young highly sportive athletes the arthroscopic repair of the isolated Bankart-Perthes lesion offers the attractive advantage of anatomic reconstruction with minimal soft tissue dissection. Further indications for arthroscopic measurements of pathologies of the glenohumeral joint are synovectomy in rheumatoid arthritis, capsulotomy of shrunk capsule in frozen shoulder and tenodesis for lesions of the long head of the biceps. The arthroscopic subacromial decompression according to Ellman is the most often and successful performed procedure at the shoulder joint and has overcome the classic Neer open acromioplasty. For smaller tears of the supraspinatus tendon the arthroscopic acromioplasty can be combined with an all arthroscopic suture repair or with an mini-open repair. Larger tears of the rotator cuff are still the domain for open reconstructive procedures. In case of associated or isolated AC-joint arthritis an arthroscopic Mumford procedure can be performed. For chronic calcific tendinitis isolated arthroscopic excision of the calcium deposit is of great value. Additionally, acromioplasty is needed for true mechanical obstruction of the subacromial space.

Acromioclavicular Joint↗
PubMed1997

[Arthroscopic surgical measures in the shoulder joint].

Arthroscopic and open surgery have to be combined for successful surgical therapy of the shoulder joint. A surgeon performing open surgery alone or just using arthroscopic measures cannot cover the full spectrum of modern shoulder surgery. Isolated diagnostic arthroscopy is rarely indicated. Far more common, diagnostic arthroscopy is combined with an operative procedure both to confirm preoperative assessment of pathology and to uncover associated lesions. The results of arthroscopic stabilization of chronic anterior post-traumatic dislocations fail to compare with the high success rates of open procedures. Better patient selection will probably be the key to improving results. In cases of acute traumatic first-time dislocation in young, highly athletic people, arthroscopic repair of the isolated Bankart-Perthes lesion offers the attractive advantage of anatomic reconstruction with minimal soft-tissue dissection. Further indications for arthroscopic measurements of pathologies of the glenohumeral joint are synovectomy in rheumatoid arthritis, capsulotomy in frozen shoulder and tenodesis for lesions of the long head of the biceps. Arthroscopic subacromial decompression according to Ellman is the procedure performed most often and most successfully in the shoulder joint and has overcome the classic Neer open acromioplasty. For smaller tears of the supraspinatus tendon, arthroscopic acromioplasty can be combined with an all arthroscopic suture repair or with mini-open repair. Larger tears of the rotator cuff are still the domain for open reconstructive procedures. In associated or isolated AC joint arthritis, an arthroscopic Mumford procedure can be performed. For chronic calcific tendinitis, isolated arthroscopic excision of the calcium deposit is of great value. Additionally, acromioplasty is needed for true mechanical obstruction of the subacromial space.

Arthritis, Rheumatoid↗
PubMed1997

[Dislocated multiple fragment fractures of the head of the humerus. Does dislocation of the humeral head fragment signify a worse prognosis?].

PROBLEM: The vascularity of the articular fragment is of key importance for the final outcome in three- and four-part fractures of the humeral head. Displacement of the articular segment may compromise the arterial blood supply to the humeral head and result in avascular necrosis. There is still controversy as to whether three-and four-part fracture dislocations (articular fragment outside the glenoid) have an even worse prognosis than displaced three- and four-part fractures. PATIENTS AND METHODS: Between January 1985 and May 1993, 102 patients with three- and four-part fractures of the humeral head were treated by ORIF (mostly tension band wiring) at our institution. In a retrospective study we analysed the functional (Constant 100 point score) and radiological outcome of 67 (66%) of these patients. There were 21 patients with fracture dislocations (FD), n = 5 type B2X, n = 5 type B3X, n = 3 type C2X, n = 8 type C3X, according to the classification of Habermeyer [7]. The "X" represents the dislocation of the articular fragment, whereas the classification to each type is done after reduction of the head. The remaining 46 patients presented with displaced, but not dislocated, three- and four-part fractures (DF), n = 24 type B2, n = 7 type B3, n = 3 type C2, n = 12 type C3. Average follow-up was 25 months (7-72 months). Patients with FD were significantly younger (average age 50 years) than patients with DF (average age 63 years, P < 0.05) and showed a significantly higher incidence of traumatic nerve or plexus lesions (FD 19%, DF 2%, P < 0.05). RESULTS: Concerning the functional results, there was no statistically significant difference between the two groups. The FD patients even showed a slight tendency to better results than patients with DF. This was true for the three-part fractures (average Constant score 78 versus 67 points), as well as for the four-part fractures (average Constant score 62 versus 55 points). The significantly younger age of the FD patients may explain their better results. The entire group of patients with three-part fractures showed a significantly better functional outcome (average Constant score 68 points) than patients with four-part fractures (average Constant score 55 points, P < 0.05). The rate of partial and total avascular necrosis of the humeral head was strongly correlated to the fracture type (number of fragments, fracture of the anatomical or surgical neck, according to the classification of Habermeyer),but again there was no difference between the FD and DF group (B2X: 20%, B3X: 20%, C2X: 33%, C3X: 63%; B2: 25%, B3: 29%, C2: 33%, C3: 67%). Astonishingly, the FD were not associated with an increased rate of avascular necrosis of the humeral head. Three (axillary nerve) out of the five observed primary nerve and plexus lesions had a full neurological recovery after 6-12 months; the two patients with alterations of the brachial plexus showed a slow tendency of improvement at follow-up (12 and 18 months), but still had gross muscular atrophy and impaired sensory function. CONCLUSION: In displaced three-and four-part fractures of the humeral head the dislocation of the articular segment does not seem to increase the risk of avascular necrosis, if treated by timely and careful ORIF with respect to the vascularity. Even with the increased risk of primary nerve and plexus lesions in fracture dislocations, good functional results can be achieved by early operative nerve decompression and fracture stabilization in this middle-aged patient group. However, older patients with displaced or dislocated four-fragment fractures through the anatomical neck (type C3) have a poor chance of a favourable outcome, and therefore primary prosthetic replacement should be considered.

Adult↗
PubMed1997

[Acromio-humeral distance and acromial shape in 3-dimensional computerized tomography reconstruction. Side comparison in supraspinatus outlet syndrome].

Mechanical irritations of the supraspinatus tendon due to a reduction of the subacromial space are considered to be a potential cause of supraspinatus outlet syndrome. The aim of the current study was, therefore, to provide a method of improved measurement of the acromiohumeral distance and the evaluation of the acromial shape. In seven patients aged 50-60 years with unilateral supraspinatus outlet syndrome, imaging with standardized, high-resolution computed tomography (CT) was performed in order to demonstrate the acromion and the subacromial space three-dimensionally. The acromiohumeral distance was measured in three reconstructed frontal sections, and the two sides of each patient were directly compared. The acromial shape was compared with the classification of Bigliani as derived from conventional radiography. Whereas the Constant Score was found to be significantly reduced in the diseased shoulders (p < 0.01), the acromiohumeral distance was not significantly lower in three standardized frontal sections. In five cases the classification of the acromial form from the conventional radiograph was confirmed by 3D CT, whereas in two cases it was shown to be different. Our results suggest that primary or secondary changes of the acromial form can be more accurately evaluated with 3D CT than with conventional radiography. A direct comparison of the two sides in patients with supraspinatus syndrome does not suggest a reduction of acromiohumeral distance in the diseased shoulder.

Female↗
PubMed1997

Determination of subacromial space width and inferior acromial mineralization by 3D CT. Preliminary data from patients with unilateral supraspinatus outlet syndrome.

A reduction of the subacromial space and an increased subacromial pressure have been considered to play an important role in the pathogenesis of rotator cuff lesions. The objective of the current study was to develop a CT based method for measuring the acromiohumeral distance and inferior acromial mineralization. In seven patients with unilateral rupture of the rotator cuff and two with impingement syndrome, transverse CT images were obtained at a section thickness of 1 mm with muscular relaxation in a standardized position. The bones were then reconstructed three-dimensionally, and the minimal vertical distance between the acromion and the humerus was determined in three secondary frontal images on both sides. The distribution of mineralization within the inferior surface of the acromion was assessed using CT osteoabsorptiometry. Although the Constant score was significantly reduced in the diseased shoulders, the width of the subacromial space was not routinely lower than on the contralateral side. In seven cases the maximal inferior acromial mineralization was identical in both shoulders, and in two cases it was lower on the affected side. These preliminary data suggest that with muscular relaxation no narrowing of the subacromial space can be detected in secondary frontal CT images, and that a potential increase of subacromial pressure is not high enough to cause a measurable increase in inferior acromial bone density. The method presented makes it possible to investigate the pathogenesis of the supraspinatus outlet syndrome in vivo with greater precision than has so far been possible with conventional radiography.

Acromion↗
PubMed1996

[Diagnosis and therapy of shoulder instability].

Shoulder instability is based on various acquired or constitutional aspects which determine the therapy and clinical outcome. In order to differentiate between traumatic and atraumatic forms of shoulder instability a careful history has to be taken. A systematic clinical examination is necessary to evaluate the shoulder joint for general laxity or true instability and especially to assess direction and degree of glenohumeral translation. The basic diagnostic imaging includes X-rays in 3 planes. CT-arthrogram and MRI may provide additional information to evaluate the intraarticular pathology. An elective therapy depends on the patients age and demands. Recurrent anterior dislocations are treated by an anatomical reconstruction of the glenohumeral ligament complex. Open or arthroscopic Bankart-repair have been established as the treatment of choice. Conservative treatment is primarily indicated in cases of atraumatic posterior or multidirectional instability. If physiotherapy fails, surgical treatment should be discussed for these patients.

Diagnosis, Differential↗
PubMed1996

[Arthroscopic aspects and chronologic outcome of lesions of the labro-ligament complex in post-traumatic antero-inferior instability of the shoulder. A prospective study of 91 cases].

PURPOSE OF THE STUDY: The authors present a prospective and mono-operator study of 91 gleno-humeral arthroscopies for post-traumatic antero-inferior instability of the shoulder. The aim of the study was to obtain a dynamic understanding of the relationship between the anatomic lesions to allow the integration of all the described lesions into literature and to produce a natural history of lesions in antero-inferior shoulder instability. MATERIALS: 91 endoscopies for post-traumatic instability of the shoulder were performed by the same surgeon. Revision chart comprised 67 purely descriptive items. For the purpose of the study, the patients were divided into 4 groups of dislocation (first dislocation: 9 cases, 1 to 2 recurrences: 12 cases; 3 to 5 recurrences: 23 cases; more than 5 recurrences: 32 cases) and 1 group of subluxation (15 cases). METHOD: The statistical evaluation of each individual data item gathered value allowed the selection of the most significant lesions and to regroup them into "lesions families", relations to the same physiopathological mechanism (traumatic or degenerative). The correlation between each lesion in terms of evolution, age and number of recurrences was studied. RESULTS: The first and most constant lesion is the periosteal avulsion of the antero-inferior labrum ("single lesion": healing potential of +/- 30 per cent, in ectopic position in +/- 90 per cent). With recurrences, the avulsion of the gleno-humeral ligament adds this "single lesion" ("double lesion". Healing potential of +/- 50 per cent, in ectopic position in +/- 90 per cent). Continuing the recurrence, we also noted a degenerative and plastic deformation under the level of the glenoid rim ("triple lesion": infra-glenoid degenerescence) then over the glenoid rim ("quadruple lesion": supra glenoid degenerescence). The age factor and duration of evolution were not negligible and one must associate the "labro-ligament complex" studies with the avulsion lesions of the long head of the biceps (SLAP lesions) in which the frequency varies from 15 per cent to 30 per cent and which was consistently present in patients above 35 years of age. DISCUSSION: The authors believe that recurrences give rise to a progressive worsening of the lesions by the sum of the separate lesions. They propose a physiopathological classification in 4 stages where each lesions has its own healing potential, which explains the apparent large variation in endoscopic aspects of antero-inferior shoulder instability. CONCLUSION: This classification should permit a precise therapeutic strategy in post-traumatic anterior instability, according to the most recent techniques of endoscopic reattachment of the labro-ligament complex.

Adolescent↗
PubMed1996

[Standardized examination of the elbow].

The elbow joint often reacts to different injury patterns of the intra- and extra-articular structures with uniform symptoms that can hardly be differentiated. Furthermore, several neural entrapment syndromes around the elbow should be taken into consideration, because they make the differential diagnosis even more difficult. Cervical nerve root and brachial plexus irritations can also be responsible for pain, which is subjectively transferred to the elbow. The purpose of the study was to improve the etiological differentiation by introducing a new standardized physical examination program. Besides the static and dynamic examination and specific stability tests, the symptoms of relevant neural compression syndromes are checked. This physical examination program represents a guideline for the systematic evaluation of the anatomical and morphological structures that are responsible for the individual symptoms.

Arm Injuries↗
PubMed1995

[Open surgical therapy of the rotator cuff].

Almost 100 years have passed since the first report of rotator cuff repair in 1898 by W. Müller. Even now new operative techniques are being developed. Various solutions for difficult extended forms of rotator cuff lesions are available besides the closed and semi-closed arthroscopic techniques. Anatomical reconstructive procedures such as local or distant tendon transfer compete with extra-anatomical procedures such as simple debridement, equatorial partial reconstruction or replacement with a delta flap. Hemiarthroplasty of the shoulder has proven to be more and more the treatment of choice in cases of inoperable rotator cuff defects with painful arthropathy. The euphoria caused by complicated reconstructive methods for massive tears has subsided due to an awareness that loss of function is inevitable in chronic degenerative tears with muscle atrophy. Reconstruction should be coordinated step by step with the operative procedure as well as adapted to the biological situation. It should definitely not be forced at any price using an algorithm for a rotator cuff tear operation, the best operative method must be selected by clinical, radiological and intraoperative criteria. The situation is completely different for an acute traumatic rotator cuff tear. Every effort should be made to perform early anatomic reconstruction in a young patient, as the function of the rotator cuff is of great importance in the working world. In contrast to degenerative changes of the rotator cuff tendon, large ruptures can be treated successfully if early immediate repair is performed. The long head of the biceps tendon plays a special role in combination with a rotator cuff tear. The concomitant lesions of the long head of biceps should not to be over-looked when repairing the rotator cuff tear. Until now, a special form of rotator cuff pathology has not received much attention--the so-called interval lesion. It is the forerunner of the rotator cuff tear. The interval lesion is a partial tear of the ligamentous structures between the supraspinatus and subscapularis tendon and leads to damage of the long head of the biceps. The interval lesion can only be diagnosed by arthroscopy or open exploration of the rotator interval.

Age Factors↗