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Der Begriff „Rehabilitation 2.0“ leitet sich von „Health 2.0“ ab und beschreibt eine patientenzentrierte Weiterentwicklung der postoperativen Nachsorge durch den Einsatz neuer Technologien wie digitale Gesundheitsplattformen, Telemedizin und künstliche Intelligenz. Die individualisierte Rehabilitation spielt dabei eine zentrale Rolle, um den Heilungsprozess zu optimieren. Demografische, psychologische und schulterspezifische Faktoren beeinflussen den Heilungsverlauf und sollten in die Nachbehandlung einfließen. Die Integration von Technologien wie Smartphone-Apps, Virtual Reality und Augmented Reality kann die Rehabilitation verbessern, die Notwendigkeit häufiger Arztbesuche verringern und das subjektive Rehabilitationserlebnis optimieren. Trotz vielversprechender Ansätze sind weitere Untersuchungen notwendig, um die Effektivität dieser Technologien umfassend zu evaluieren.

Läsionen und Rupturen der Rotatorenmanschette sind ein häufiger Grund für Schulterbeschwerden. Die Sehnenrekonstruktion hat sich heute als erfolgreiches operatives Behandlungsverfahren etabliert. Leider besteht hinsichtlich der sich anschließenden Rehabilitation und deren Inhalte kein Konsens. Das Ziel ist es, die wichtigsten Therapieinhalte nach Rekonstruktion der Rotatorenmanschette anhand einer umfassenden Literaturrecherche evidenzbasiert zu bewerten und mit Hilfe einer Umfrage unter ausgewiesenen DVSE-Schulterexperten (Deutsche Vereinigung für Schulter- und Ellenbogenchirurgie e. V.) einen evtl. bestehenden Konsens für oder gegen spezifische Therapieinhalte zu eruieren. Die Literatursuche erfolgte nach Leitlinien, „health technology assessments“, systematischen Übersichtsarbeiten und klinischen Studien, die die postoperative Rehabilitation nach Rekonstruktion der Rotatorenmanschette untersuchten. Abgefragt wurden die Datenbanken des „Guidelines International Network“, diverse nationale Leitlinien, PubMed, das „Cochrane Central Register of Controlled Trials“, die „Cochrane Database of Systematic Reviews“ und die „Physiotherapy Evidence Database“, jeweils für den Zeitraum 01/2004 bis 10/2014. Im Rahmen einer Online-Umfrage wurden 63 ausgewählte DVSE-Experten zu spezifischen Therapieinhalten der Rehabilitation befragt. Im Zeitraum seit 2004 ließen sich eine Leitlinie, 4 Reviews und 17 Originalarbeiten identifizieren, die als Grundlage zum Aufbau einer strukturierten Nachbehandlung dienten. In Zusammenschau aller Ergebnisse und unter Einschluss der DVSE-Expertenmeinungen konnte ein Grundkonzept der Nachbehandlung erstellt werden, welches in einem Vier-Phasen-Modell zusammengefasst wurde. Tears and lesions of the rotator cuff are a frequent cause of shoulder pain and disability. Surgical repair of the rotator cuff is a valuable procedure to improve shoulder function and decrease pain. However, there is no consensus concerning the rehabilitation protocol following surgery. To review and evaluate current rehabilitation contents and protocols after rotator cuff repair by reviewing the existing scientific literature and providing an overview of the clinical practice of selected German Society of Shoulder and Elbow Surgery e.V. (DVSE) shoulder experts. A literature search for the years 2004–2014 was conducted in relevant databases and bibliographies including the Guidelines International Network, National Guidelines, PubMed, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and the Physiotherapy Evidence Database. In addition, 63 DVSE experts were contacted via an online questionnaire. A total of 17 studies, four reviews, and one guideline fulfilled the inclusion criteria. Based on these results and the obtained expert opinions, a four-phase rehabilitation protocol could be developed.

Rupturen der Rotatorenmanschette (RM) sind mit einer erheblichen Dysfunktion und Schmerzen der betroffenen Schulter verbunden. Häufig persistiert eine deutliche Einschränkung der Lebensqualität der Patienten trotz Ausschöpfung der konservativen Therapie, so dass der Wunsch nach einer operativen Rekonstruktion mit dem Ziel der Schmerzfreiheit und Wiederherstellung der Funktion in den Vordergrund tritt. Durch die Weiterentwicklung arthroskopischer Techniken und innovativer Materialen geschieht dies heute zum größten Teil minimal-invasiv. Dennoch stehen den Erkenntnissen und Errungenschaften aus biomechanischen Studien mit dem Ziel der anatomischen Rekonstruktion die weiterhin hohen Rerupturraten gegenüber. Dies liegt zu einem großen Teil an der Komplexität der physiologischen Sehnenheilung, welche sich in drei Phasen unterteilen lässt: die Inflammation, die Reparation und letztlich das Remodeling. Trotz intensiver Forschung sind die biologischen Grundlagen noch nicht abschließend bekannt. So stellt weiterhin die Regeneration einer nativen Enthese nach RM-Rekonstruktion (RMR) die größte Herausforderung dar. Neben der operativen Therapie nimmt die postoperative Rehabilitation eine vergleichbare Stellung ein. Hier wird weiterhin nach dem optimalen Zeitpunkt und Intensität für den Beginn der Beübung gesucht. Durch frühe passive Bewegungen wird zum einen der Bewegungsumfang der Schulter verbessert, und zum anderen kommt es zur einer verstärkten Aktivierung von Fibroblasten mit Erhöhung der Kollagensynthese. Anderseits kann eine zu forcierte Nachbehandlung mit Rerupturen und insuffizienter Sehneneinheilung assoziiert sein. Zusätzlich können eine Reihe von patientenspezifischen und operateurabhängigen Faktoren die Einheilungschancen beeinflussen. Hierzu zählen das Patientenalter, Ausmaß und Retraktion der Sehne, Vorhandensein von fortgeschrittenen degenerativen Veränderungen, Nebenerkrankung und Nikotinabusus ebenso wie die individuellen Fertigkeiten des Operateurs, verwendete Operations- und Fixationstechnik. Diese individuellen Aspekte müssen in den Therapie- und Rehabilitationsplan mit einfließen. Um die Einheilung nach Rekonstruktion zu verbessern und eine schnellere Rehabilitation zu ermöglichen, werden neue und innovative biologische Augmentationsmöglichkeiten erforscht. Im folgenden Artikel werden die Grundlagen der Sehneneinheilung und ihre Konsequenzen für die Belastbarkeit der heilenden Enthese im postoperativen Verlauf dargestellt. Rotator cuff tears are associated with significant shoulder dysfunction and pain. Despite conservative management, many patients persistently have decreased quality of life warranting surgical repair as a more appropriate treatment option. Using new arthroscopic methods, a wider range of rotator cuff tears can be reconstructed using minimally invasive techniques. Biomechanical studies which focus on the repair or reconstruction of the rotator cuff in order to restore function have been published. However, the re-tear rate remains high. This is partially due to the complexity of tendon regeneration, which is largely described as a three-stage process consisting of inflammation, followed by reparation, and finally a remodeling phase. Despite investigation of the biological principles in tendon healing, the mechanism is not yet completely understood. The ability to recreate a native enthesis between tendon and bone after rotator cuff repair is the ideal treatment goal. In addition to surgical treatment, postoperative rehabilitation is also critical to achieve full shoulder function. The appropriate time to start rehabilitation and passive motion is still controversial. To begin immediately may lead to an improvement in range of motion as well as enhanced collagen synthesis by stimulating fibroblasts, while, initiating rehabilitation too soon could risk re-tear or result in inferior healing of the tendon. Biological augmentation may be an option to improve the healing process, therefore, allowing more rapid rehabilitation without compromising the repair. This article provides an overview of tendon healing principles as well as presumed enthesis stability during the healing process.

Shoulder pain is frequently seen in overhead athletes. The diagnosis and treatment are often difficult because of multiple factors. However, this variable group of patients can be classified into three main groups according to the requirements of their specific sports: (1) injuries caused by internal impingement (posterosuperior impingement and anterosuperior impingement); (2) injuries caused by acquired macro- or micro-traumatic instability with secondary internal impingement; and (3) injuries caused by rotator cuff-associated pain due to hyperlaxity/multidirectional instability. A structured approach to the evaluation of these athletes is presented and specific key factors are suggested to define the best treatment option.

Ein 45-jähriger Volleyballspieler stellt sich mit seit sechs Monaten bestehenden Beschwerden im rechten Schultergelenk vor. Ein Trauma sei nicht erinnerlich. Die Symptome treten vor allem während des Aufschlags und bei Schmetterbewegungen mit Ausstrahlung in den proximalen Oberarm auf. Nachtschmerz oder ein subjektives Instabilitätsgefühl werden verneint.

Tears and lesions of the rotator cuff are a frequent cause of shoulder pain and disability. Surgical repair of the rotator cuff is a valuable procedure to improve shoulder function and decrease pain. However, there is no consensus concerning the rehabilitation protocol following surgery. To review and evaluate current rehabilitation contents and protocols after rotator cuff repair by reviewing the existing scientific literature and providing an overview of the clinical practice of selected German Society of Shoulder and Elbow Surgery e. V. (DVSE) shoulder experts. A literature search for the years 2004–2014 was conducted in relevant databases and bibliographies including the Guidelines International Network, National Guidelines, PubMed, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and the Physiotherapy Evidence Database. In addition, 63 DVSE experts were contacted via online questionnaire. A total of 17 studies, four reviews and one guideline fulfilled the inclusion criteria. Based on these results and the obtained expert opinions, a four-phase rehabilitation protocol could be developed.

Acromioclavicular joint (ACJ) stabilizations are associated with a high overall failure rate, while 9.5 % of these patients requiring subsequent revision surgery. Consequently, understanding the specific cause of primary ACJ stabilization failure is paramount to improving surgical decision making in this challenging patient cohort.

Acromioclavicular (AC) joint injuries are a common cause of shoulder pain, especially among athletes. Surgical reconstruction of the AC joint can lead to complications such as fracture of the coracoid process, clavicle or acromion, which can negatively affect the patient's outcome. The purpose of this review is to discuss the risk factors for fractures associated with AC joint reconstruction, as well as the strategies that can be used to mitigate this risk. Risk factors for fractures include low mineral density, coracoid/clavicle drilling, larger holes in the coracoid, and the number of tunnels used for reconstruction.

This article summarizes both the various techniques for an open subpectoral biceps tenodesis as well as the biomechanics associated with these procedures. It provides information regarding the indications and contraindications to support the surgeon's decision. Furthermore, a postoperative protocol as well as an outcome overview is presented to address postoperative care. A short summary of the recent literature regarding potential complications is included to provide further insight on this technique. The open subpectoral tenodesis of the long head of the biceps is a safe and reproducible technique with a low complication rate for patients with pathologies of the proximal biceps.

Rupture of the distal biceps tendon is an uncommon injury that usually results from an excessive eccentric load across the biceps tendon. Various operative techniques have been described but anatomical repair is preferred to restore near native function in patients for whom such deficits would be debilitating. Boyd and Anderson originally described a 2-incision technique that minimizes the incidence of surgical complications while restoring anatomical function. This technique was further modified by Morrey to reduce the rate of ectopic bone formation that has been observed in the original Boyd-Anderson approach. With Morrey’s modification, the 2-incision approach is a safe and effective method for repair of a distal biceps tendon rupture. We describe the modified procedure in full and report on recovery, complications, and comparative outcomes. [ABSTRACT FROM AUTHOR]

The proximal biceps tendon is a unique structure that can be a pain generator frustrating for both patient and clinician. Its anatomic position in close relation to other critical structures of the joint, such as the RC, makes it prone for biomechanical stresses, as well as difficult to isolate as a sole cause of shoulder pain and dysfunction. The tendon originates with variable fiber insertions from the glenoid labrum and supraglenoid tubercle with slight anatomic variations. Before entering the intertubercular groove, the tendon is guided by the structures of the “pulley” system, which include the tendon of the supraspinatus and subscapularis muscle. Therefore, lesions of the long head of the biceps tendon are often combined with other significant pathologies of the glenohumeral joint. The function of the long head of the biceps tendon may be more of a proprioceptive one, although significant stress may arise when the rotator cuff is insufficient. An accurate history and complete physical examination are critical to find the exact diagnosis and initiate the correct treatment. [Copyright &y& Elsevier]

Numerous studies have demonstrated a positive clinical response to platelet-rich plasma injections. However, few randomized, clinically controlled trials have been published. An equal number of publications have shown no effect. As of yet, no deleterious effects have been identified. A literature search of articles pertaining to platelet-rich plasma reveals thousands of publications but is remarkable for how much remains unknown. This review attempts to use the latest published research to answer the most frequently asked questions surrounding platelet-rich plasma and to provide a fundamental understanding for critically evaluating further platelet-rich plasma studies.

Injuries to the acromioclavicular joint complex that are considered unstable or for which conservative treatment has failed can be managed with surgical procedures intended to provide joint reduction. Despite a large collection of publications describing a variety of surgical procedures directed towards a common goal, no treatment option has emerged as a “gold standard” of care. There appears to be a renewed interest in the acromioclavicular joint as technology over the last decade has offered new advancements that are being applied to the surgical treatment of acromioclavicular joint complex dislocations. This review is intended to summarize and review papers published in the last 2 years on new techniques, complications of reported techniques, and biomechanical studies designed to examine reconstruction strategies.

Isolated Bankart repair for shoulder instability has been associated with recurrences. A concept of dynamic anterior stabilization (DAS) by transferring the long head of the biceps (LHB) within a subscapularis split to the anterior glenoid margin, thereby creating a “sling effect” has recently been proposed. Therefore, our purpose was to compare the biomechanical effects of these two procedures.

Long head biceps tendon pathology is a common cause of anterior shoulder pain and is often associated with other shoulder conditions, such as rotator cuff tears and osteoarthritis. It is well accepted that older patients are at increased risk for major and minor peri- and postoperative complications. The purpose of this study is to investigate patients over 65 years old who underwent subpectoral biceps tenodesis and compare the complication rates of this group to those of patients younger than 65 years old. The hypothesis is, that there would be no difference in complication rates and that clinical outcome scores for patients over 65 were satisfying and showed improvements over time.