Arthroskopische subakromiale Dekompression in Kombination mit Rotatorenmanschettenrekonstruktionen: Vor- und Nachteile

Arthroscopic subacromial decompression (ASAD) is one of the most commonly performed procedures. The ASAD procedure is indicated in patients with primary extrinsic impingement syndrome of the shoulder with bony narrowing of the subacromial space and resulting symptoms. Preservation of the coracoacromial ligament (CAL) is crucial due to its function as anterosuperior abutment of the coracoacromial arch in order to prevent translation of the humeral head. Resection of the CAL leads to anterosuperior instability with subsequent translation of the humeral head, which increases the rotator cuff force required to maintain physiologic glenohumeral biomechanics. In the surgical treatment of rotator cuff tears, the routine performance of ASAD is discussed controversially. Randomized controlled trials show no significant difference in functional results and revision rate for patients who had rotator cuff repair with or without subacromial decompression. Therefore, there is currently no scientific evidence for routine performance of subacromial decompression in rotator cuff repair. Further studies that concentrate on the acromial morphology as a crucial, mechanical narrowing factor are necessary to develop evidence-based guidelines. Besides the acromion type according to Bigliani, the focus should be on the lateral acromion angle and the acromial index to assess the position and the lateral extension of the acromion in relation to the humeral head.