Die subakromiale Bursa – Fluch oder Segen?

The functionality of the subacromial bursa (SAB) is essential for healthy shoulder kinematics, as it is an important sensory organ for proprioception, nociception, and neuromuscular coordination. Inflammatory changes in the SAB are a common cause of shoulder pain, given the increased presence of immune cells and modulators. However, it is unclear how these immune cells affect the adjacent tissue. In this case, subacromial decompression is a common surgical treatment, but its benefit is controversially discussed. Other therapeutic approaches focus on reducing inflammatory mediators such as SDF‑1 and IL-1β through COX-2 inhibitors, steroids, and TAK-1 inhibitors, as well as inhibiting TNF‑α. The debate over whether subacromial bursitis is the cause or consequence of a rotator cuff (RC) lesion remains. The SAB plays a central role in the healing of rotator cuff lesions by serving as a primary source of neovascularizing signals and fibroblastic cells. The SAB acts as a reservoir for mesenchymal stem sells (MSCs), which show high differentiation and proliferation potential. However, the exact function of the SAB in this process remains unclear. Biological augmentation in rotator cuff repair leverages the healing potential of the SAB. In vitro studies show significant cell migration and proliferation, as well as improved failure load through augmentation with SAB cells. The clinical application of SAB for biological augmentation in arthroscopic RC repair shows promising preliminary results. However, the evidence is currently limited, necessitating higher quality studies to evaluate its effectiveness.