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Arthropedia – Grundlagenwissen und Fallbeispiele

07.07.2020 | Arthropedia | Online-Artikel

Traumatische vordere Schultererstluxation

Operative Therapie

(F. Marteschläger)


Bankart Repair: Indikation und Zeitpunkt zur primär operativen Therapie

  1. Rowe CR. Acute and recurrent anterior dislocations of the shoulder. Orthop Clin North Am 1980; 11(2): 253-70.
  2. Simonet WT, Cofield RH. Prognosis in anterior shoulder dislocation. Am J Sports Med 1984; 12(1): 19-24.
  3. Taylor DC, Arciero RA. Pathologic changes associated with shoulder dislocations. Arthroscopic and physical examination findings in first-time, traumatic anterior dislocations. Am J Sports Med 1997; 25(3): 306-11.
  4. Randelli P, Taverna E. Primary anterior shoulder dislocation in young athletes: fix them! Knee Surg Sports Traumatol Arthrosc 2009; 17(12): 1404-5.
  5. Martetschlager F, Imhoff AB. (Shoulder dislocation in athletes. Current therapy concepts). Orthopade 2014; 43(3): 236-43.
  6. Plath JE, Aboalata M, Seppel G, et al. Prevalence of and Risk Factors for Dislocation Arthropathy: Radiological Long-term Outcome of Arthroscopic Bankart Repair in 100 Shoulders at an Average 13-Year Follow-up. Am J Sports Med 2015; 43(5): 1084-90.
  7. Hovelius L, Olofsson A, Sandstrom B, et al. Nonoperative treatment of primary anterior shoulder dislocation in patients forty years of age and younger. a prospective twenty-five-year follow-up. J Bone Joint Surg Am 2008; 90(5): 945-52.
  8. Martetschlager F, Tauber M, Habermeyer P. (Diagnostics and treatment concepts for anteroinferior shoulder instability: Current trends). Orthopade 2017; 46(10): 877-92.
  9. De Carli A1, Vadalà AP2, Lanzetti R2, Lupariello D2, Gaj E2, Ottaviani G2, Patel BH3, Lu Y3, Ferretti A2. Early surgical treatment of first-time anterior glenohumeral dislocation in a young, activepopulation is superior to conservative management at long-term follow-up. Int Orthop. 2019 Aug 7. doi: 10.1007/s00264-019-04382-2. (Epub ahead of print)

OP-Technik der arthroskopischen Weichteilstabilisierung

  1. Rachel M. Frank, et al (2014). Outcomes of Arthroscopic Anterior Shoulder Instability in the Beach Chair Versus Lateral Decubitus Position: A Systematic Review and Meta-Regression Analysis. Arthroscopy : the Journal of Arthroscopic & Related Surgery : Official Publication of the Arthroscopy Association of North America and the International Arthroscopy Association, 30(10), 1349–1365.
  2. Randelli, P., Ragone, V., Carminati, S., & Cabitza, P. (2012). Risk factors for recurrence after Bankart repair a systematic review. Knee Surgery, Sports Traumatology, Arthroscopy : Official Journal of the ESSKA, 20(11), 2129–2138.
  3. Barber FA, Lee Evanson JR. Editorial Commentary: Acetabular Labral Repair-Is A Knotless Anchor Better? Arthroscopy. 2019 Jan;35(1):77-79. doi: 10.1016/j.arthro.2018.09.003.)
  4. Ng DZ, Kumar VP. Arthroscopic Bankart repair using knot- tying versus knotless suture anchors: Is there a difference? Arthroscopy 2014;30:422-427.
  5. Martetschläger, F., Michalski, M. P., Jansson, K. S., Wijdicks, C. A., & Millett, P. J. (2013). Biomechanical evaluation of knotless anterior and posterior Bankart repairs. Knee Surgery, Sports Traumatology, Arthroscopy : Official Journal of the ESSKA, 22(9), 2228–2236.
  6. Kim SH et al (2013). Movement-Induced Knot Migration After Anterior Stabilization in the Shoulder. Arthroscopy : the Journal of Arthroscopic & Related Surgery : Official Publication of the Arthroscopy Association of North America and the International Arthroscopy Association, 29(3), 485–490.
  7. Alexander, S., & Wallace, A. L. (2014). The “Flying Swan” Technique: A Novel Method for Anterior Labral Repair Using a Tensioned Suture Bridge. Arthroscopy Techniques, 3(1), e119–e122.
  8. Ostermann, R. C., Hofbauer, M., Platzer, P., & Moen, T. C. (2015). The “Labral Bridge”: A Novel Technique for Arthroscopic Anatomic Knotless Bankart Repair. Arthroscopy Techniques, 4(2), e91–5.
  9. Lafosse L, Baier GP, Jost B. Footprint fixation for arthroscopic reconstruction in anterior shoulder instability: the Cassiopeia double- row technique. Arthroscopy 2006;22:e231-6.

Ergebnisse nach arthroskopischer Weichteilstabilisierung

  1. Robinson, C. M., Jenkins, P. J., White, T. O., Ker, A., & Will, E. (2008). Primary Arthroscopic Stabilization for a First-Time Anterior Dislocation of the Shoulder. The Journal of Bone and Joint Surgery American Volume, 90(4), 708–721.
  2. Gigis I, et al; Arthroscopic Versus Conservative Treatment of First Anterior Dislocation of the Shoulder in Adolescents. Journal of Pediatric Orthopaedics. 34(4):421–425, JUN 2014
  3. Larrain, M. V., Botto, G. J., Montenegro, H. J., & Mauas, D. M. (2001). Arthroscopic repair of acute traumatic anterior shoulder dislocation in young athletes. Arthroscopy: the Journal of Arthroscopic & Related Surgery, 17(4), 373–377.
  4. Larrain, M. V., Montenegro, H. J., Mauas, D. M., Collazo, C. C., & Pavón, F. (2006). Arthroscopic Management of Traumatic Anterior Shoulder Instability in Collision Athletes: Analysis of 204 Cases With a 4- to 9-Year Follow-Up and Results With the Suture Anchor Technique. Arthroscopy: the Journal of Arthroscopic & Related Surgery, 22(12), 1283–1289.
  5. Law, B. K.-Y., Yung, P. S.-H., Ho, E. P.-Y., Chang, J. J. H.-T., & Chan, K. M. (2007). The surgical outcome of immediate arthroscopic Bankart repair for first time anterior shoulder dislocation in young active patients. Knee Surgery, Sports Traumatology, Arthroscopy : Official Journal of the ESSKA, 16(2), 188–193.
  6. Valentin, A., Winge, S., & Engström, B. (1998). Early arthroscopic treatment of primary traumatic anterior shoulder dislocation. A follow-up study. Scandinavian Journal of Medicine & Science in Sports, 8(6), 405–410.
  7. Yanmis I, Tunay S, Kömürcü M, Yildiz C, Tunay VB, Gür E. Outcomes of acute arthroscopic repair and conservative treatment following first traumatic dislocation of the shoulder joint in young patients. Ann Acad Med Singapore. 2003 Nov;32(6):824-7.
  8. Bottoni, C. R., Wilckens, J. H., DeBerardino, T. M., D'Alleyrand, J.-C. G., Rooney, R. C., Harpstrite, J. K., & Arciero, R. A. (2002). A prospective, randomized evaluation of arthroscopic stabilization versus nonoperative treatment in patients with acute, traumatic, first-time shoulder dislocations. The American Journal of Sports Medicine, 30(4), 576–580.
  9. Kirkley A, Griffin S, Richards C et al (1999) Prospective random- ized clinical trial comparing the effectiveness of immediate arthro- scopic stabilization versus immobilization and rehabilitation in first traumatic anterior dislocations of the shoulder. Arthroscopy 15: 507–514.
  10. Arciero RA, Wheeler JH, Ryan JB, McBride JT (1994) Arthroscopic Bankart repair versus nonoperative treatment for acute, initial anterior shoulder dislocations. Am J Sports Med 22: 589–594.
  11. Kim, D.-S., Yi, C.-H., & Yoon, Y.-S. (2011). Arthroscopic repair for combined Bankart and superior labral anterior posterior lesions: a comparative study between primary and recurrent anterior dislocation in the shoulder. International Orthopaedics, 35(8), 1187–1195
  12. Chapus, V., Rochcongar, G., Pineau, V., de Chou, É. S., & Hulet, C. (2015). Ten-year follow-up of acute arthroscopic Bankart repair for initial anterior shoulder dislocation in young patients, 1–5.
  13. Marshall, T., Vega, J., Siqueira, M., Cagle, R., Gelber, J. D., & Saluan, P. (2017). Outcomes After Arthroscopic Bankart Repair: Patients With First-Time Versus Recurrent Dislocations. The American Journal of Sports Medicine, 45(8), 1776–1782.
  14. Nixon MF, Keenan O, Funk L (2015) High recurrence of instability in adolescents playing contact sports after arthroscopic shoulder stabilization. J Pediatr Orthop B 24:173–177.

Knöcherne Beteiligung bei traumatischer Erstluxation

  1. Di Giacomo G, Itoi E, Burkhart SS. Evolving concept of bipolar bone loss and the Hill-Sachs lesion: from "engaging/non-engaging" lesion to "on-track/off-track" lesion. Arthroscopy. 2014;30(1):90–8. doi: 10.1016/j.arthro.2013.10.004. PubMed PMID: 24384275.
  2. Griffith JF, Antonio GE, Yung PSH, Wong EMC, Yu AB, Ahuja AT, et al. Prevalence, pattern, and spectrum of glenoid bone loss in anterior shoulder dislocation: CT analysis of 218 patients. AJR Am J Roentgenol. 2008;190(5):1247–54. doi: 10.2214/AJR.07.3009. PubMed PMID: 18430839.
  3. Sugaya H, Moriishi J, Dohi M, Kon Y, Tsuchiya A. Glenoid rim morphology in recurrent anterior glenohumeral instability. J Bone Joint Surg Am. 2003;85(5):878–84. doi: 10.2106/00004623-200305000-00016. PubMed PMID: 12728039.
  4. Burkhart SS, Debeer JF, Tehrany AM, Parten PM. Quantifying glenoid bone loss arthroscopically in shoulder instability. Arthroscopy. 2002;18(5):488–91. doi: 10.1053/jars.2002.32212. PubMed PMID: 11987058.
  5. Bhatia S, Saigal A, Frank RM, Bach BR, Cole BJ, Romeo AA, et al. Glenoid diameter is an inaccurate method for percent glenoid bone loss quantification: analysis and techniques for improved accuracy. Arthroscopy. 2015;31(4):608-614.e1. doi: 10.1016/j.arthro.2015.02.020. PubMed PMID: 25842231.
  6. Walter WR, Samim M, LaPolla FWZ, Gyftopoulos S. Imaging Quantification of Glenoid Bone Loss in Patients With Glenohumeral Instability: A Systematic Review. AJR Am J Roentgenol. 2019:1–10. doi: 10.2214/AJR.18.20504. PubMed PMID: 30835517.
  7. Vopat BG, Cai W, Torriani M, Vopat ML, Hemma M, Harris GJ, et al. Measurement of Glenoid Bone Loss With 3-Dimensional Magnetic Resonance Imaging: A Matched Computed Tomography Analysis. Arthroscopy. 2018;34(12):3141–7. doi: 10.1016/j.arthro.2018.06.050. PubMed PMID: 30396796.
  8. Di Giacomo G, Gasperis N de, Scarso P. Bipolar bone defect in the shoulder anterior dislocation. Knee Surg Sports Traumatol Arthrosc. 2016;24(2):479–88. doi: 10.1007/s00167-015-3927-7. PubMed PMID: 26704802.
  9. Di Giacomo G, Piscitelli L, Pugliese M. The role of bone in glenohumeral stability. EFORT Open Rev. 2018;3(12):632–40. doi: 10.1302/2058-5241.3.180028. PubMed PMID: 30697443.
  10. Maquieira GJ, Espinosa N, Gerber C, Eid K. Non-operative treatment of large anterior glenoid rim fractures after traumatic anterior dislocation of the shoulder. J Bone Joint Surg Br. 2007;89(10):1347–51. doi: 10.1302/0301-620X.89B10.19273. PubMed PMID: 17957076.
  11. Shin S-J, Kim RG, Jeon YS, Kwon TH. Critical Value of Anterior Glenoid Bone Loss That Leads to Recurrent Glenohumeral Instability After Arthroscopic Bankart Repair. Am J Sports Med. 2017;45(9):1975–81. doi: 10.1177/0363546517697963. PubMed PMID: 28333542.
  12. Klemt C, Toderita D, Nolte D, Di Federico E, Reilly P, Bull AMJ. The critical size of a defect in the glenoid causing anterior instability of the shoulder after a Bankart repair, under physiological joint loading. Bone Joint J. 2019;101-B(1):68–74. doi: 10.1302/0301-620X.101B1.BJJ-2018-0974.R1. PubMed PMID: 30601049.
  13. Dickens JF, Owens BD, Cameron KL, DeBerardino TM, Masini BD, Peck KY, et al. The Effect of Subcritical Bone Loss and Exposure on Recurrent Instability After Arthroscopic Bankart Repair in Intercollegiate American Football. Am J Sports Med. 2017;45(8):1769–75. doi: 10.1177/0363546517704184. PubMed PMID: 28474965.
  14. Hurley ET, Jamal MS, Ali ZS, Montgomery C, Pauzenberger L, Mullett H. Long-term outcomes of the Latarjet procedure for anterior shoulder instability: a systematic review of studies at 10-year follow-up. J Shoulder Elbow Surg. 2019;28(2):e33-e39. doi: 10.1016/j.jse.2018.08.028. PubMed PMID: 30545784.
  15. Moroder P, Schulz E, Wierer G, Auffarth A, Habermeyer P, Resch H, et al. Neer Award 2019: Latarjet procedure vs. iliac crest bone graft transfer for treatment of anterior shoulder instability with glenoid bone loss: a prospective randomized trial. J Shoulder Elbow Surg. 2019. doi: 10.1016/j.jse.2019.03.035. PubMed PMID: 31129017.
  16. Burkhart SS, Beer JF de, Barth JRH, Cresswell T, Criswell T, Roberts C, et al. Results of modified Latarjet reconstruction in patients with anteroinferior instability and significant bone loss. Arthroscopy. 2007;23(10):1033–41. doi: 10.1016/j.arthro.2007.08.009. PubMed PMID: 17916467.
  17. Boileau P, Thélu C-É, Mercier N, Ohl X, Houghton-Clemmey R, Carles M, et al. Arthroscopic Bristow-Latarjet combined with bankart repair restores shoulder stability in patients with glenoid bone loss. Clin Orthop Relat Res. 2014;472(8):2413–24. doi: 10.1007/s11999-014-3691-x. PubMed PMID: 24942959.
  18. Steffen V, Hertel R. Rim reconstruction with autogenous iliac crest for anterior glenoid deficiency: forty-three instability cases followed for 5-19 years. J Shoulder Elbow Surg. 2013;22(4):550–9. doi: 10.1016/j.jse.2012.05.038. PubMed PMID: 22947237.
  19. Taverna E, Garavaglia G, Perfetti C, Ufenast H, Sconfienza LM, Guarrella V. An arthroscopic bone block procedure is effective in restoring stability, allowing return to sports in cases of glenohumeral instability with glenoid bone deficiency. Knee Surg Sports Traumatol Arthrosc. 2018;26(12):3780–7. doi: 10.1007/s00167-018-4921-7. PubMed PMID: 29623353.
  20. Bockmann B, Venjakob AJ, Reichwein F, Hagenacker M, Nebelung W. Mid-term clinical results of an arthroscopic glenoid rim reconstruction technique for recurrent anterior shoulder instability. Arch Orthop Trauma Surg. 2018;138(11):1557–62. doi: 10.1007/s00402-018-2964-3. PubMed PMID: 29948225.
  21. Kitayama S, Sugaya H, Takahashi N, Matsuki K, Kawai N, Tokai M, et al. Clinical Outcome and Glenoid Morphology After Arthroscopic Repair of Chronic Osseous Bankart Lesions: A Five to Eight-Year Follow-up Study. J Bone Joint Surg Am. 2015;97(22):1833–43. doi: 10.2106/JBJS.N.01033. PubMed PMID: 26582613.
  22. Godin JA, Altintas B, Horan MP, Hussain ZB, Pogorzelski J, Fritz EM, et al. Midterm Results of the Bony Bankart Bridge Technique for the Treatment of Bony Bankart Lesions. Am J Sports Med. 2019;47(1):158–64. doi: 10.1177/0363546518808495. PubMed PMID: 30485124.
  23. Bonnevialle N, Clavert P, Arboucalot M, Bahlau D, Bauer T, Ehlinger M. Contribution of arthroscopy in the treatment of anterior glenoid rim fractures: a comparison with open surgery. J Shoulder Elbow Surg. 2019;28(1):42–7. doi: 10.1016/j.jse.2018.07.008. PubMed PMID: 30262253.

Nachbehandlung nach operativer Therapie

  1. Cools AM, Borms D, Castelein B, Vanderstukken F, Johansson FR. Evidence-based rehabilitation of athletes with glenohumeral instability. Knee Surg Sports Traumatol Arthrosc. 2016;24(2):382-389.
  2. DeFroda SF, Mehta N, Owens BD. Physical Therapy Protocols for Arthroscopic Bankart Repair. Sports Health. 2018;10(3):250-258.
  3. Gaunt BW, Shaffer MA, Sauers EL, Michener LA, McCluskey GM, Thigpen C, American Society of S, Elbow T. The American Society of Shoulder and Elbow Therapists' consensus rehabilitation guideline for arthroscopic anterior capsulolabral repair of the shoulder. J Orthop Sports Phys Ther. 2010;40(3):155-168.
  4. Johnson M. Rehabilitation Following Surgery for Glenohumeral Instability. Sports Med Arthrosc Rev. 2017;25(3):116-122.
  5. Kasik CS, Rosen MR, Saper MG, Zondervan RL. High rate of return to sport in adolescent athletes following anterior shoulder stabilisation: a systematic review. J ISAKOS. 2019;4(1):33-40.
  6. Kim SH, Ha KI, Jung MW, Lim MS, Kim YM, Park JH. Accelerated rehabilitation after arthroscopic Bankart repair for selected cases: a prospective randomized clinical study. Arthroscopy. 2003;19(7):722-731.
  7. Ma R, Brimmo OA, Li X, Colbert L. Current Concepts in Rehabilitation for Traumatic Anterior Shoulder Instability. Curr Rev Musculoskelet Med. 2017;10(4):499-506.
  8. Nachbehandlunsgempfehlungen 2018, Arbeitskreis Traumarehabilitation, Sektion Physikalische Therapie und Rehabilitation der DGOU
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