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01.08.2022 | Arthropedia | Online-Artikel

Fallbeispiel

Instabilitäten des Akromioklavikulargelenks – Komplikationen und Lehren

Neue Techniken als Antwort

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Die Versorgungstechniken von Instabilitäten des Akromioklavikulargelenks (ACG) haben sich im Laufe der Zeit von der rein offenen Chirurgie hin zu arthroskopisch bzw. arthroskopisch assistierten Verfahren entwickelt. Bisher existiert kein Goldstandard, da verschiedene Interventionen mit einer Reihe möglicher Komplikationen bzw. potenzieller Fehlschläge verbunden sind. Im folgenden Artikel sollen die Problematiken der unterschiedlichen Methoden beschrieben werden, um daraus die aktuell zu favorisierenden Techniken abzuleiten und die verbleibenden offenen Fragen zu thematisieren.

Literatur
  1. Balke M, Schneider MM, Akoto R, Bäthis H, Bouillon B, Banerjee M (2015) Die akute Schultereckgelenkverletzung: Diagnostik, Therapie und Entwicklungen der letzten 10 Jahre. Unfallchirurg 118(10):851–857. https://doi.org/10.1007/s00113-013-2547-2
  2. Bäthis H, Tingart M, Bouillon B, Tiling T (2001) Stand der Therapie der Schultereckgelenkverletzung. Unfallchirurg 104(10):955–960. https://doi.org/10.1007/s001130170036
  3. Maziak N, Audige L, Hann C, Minkus M, Scheibel M (2019) Factors predicting the outcome after arthroscopically assisted stabilization of acute high-grade acromioclavicular joint dislocations. Am J Sports Med 47(11):2670–2677. https://doi.org/10.1177/0363546519862850
  4. Beitzel K, Cote MP, Apostolakos J, Solovyova O, Judson CH, Ziegler CG et al (2013) Current concepts in the treatment of acromioclavicular joint dislocations. Arthroscopy 29(2):387–397
  5. Walz L, Salzmann GM, Fabbro T, Eichhorn S, Imhoff AB (2008) The anatomic reconstruction of acromioclavicular joint dislocations using 2 tightrope devices: a biomechanical study. Am J Sports Med 36(12):2398–2406. https://doi.org/10.1177/0363546508322524
  6. Gowd AK, Liu JN, Cabarcas BC, Cvetanovich GL, Garcia GH, Manderle BJ et al (2019) Current concepts in the operative management of acromioclavicular dislocations: a systematic review and meta-analysis of operative techniques. Am J Sports Med 47(11):2745–2758. https://doi.org/10.1177/0363546518795147
  7. Dyrna F, Berthold DP, Feucht MJ, Muench LN, Martetschläger F, Imhoff AB et al (2019) The importance of biomechanical properties in revision acromioclavicular joint stabilization: a scoping review. Knee Surg Sports Traumatol Arthrosc 27(12):3844–3855. https://doi.org/10.1007/s00167-019-05742-6
  8. Rolf O, Hann von Weyhern A, Ewers A, Boehm TD, Gohlke F (2008) Acromioclavicular dislocation Rockwood III–V: results of early versus delayed surgical treatment. Arch Orthop Trauma Surg 128(10):1153–1157. https://doi.org/10.1007/s00402-007-0524-3
  9. Song T, Yan X, Ye T (2016) Comparison of the outcome of early and delayed surgical treatment of complete acromioclavicular joint dislocation. Knee Surg Sports Traumatol Arthrosc 24(6):1943–1950. https://doi.org/10.1007/s00167-014-3225-9
  10. Dumontier C, Sautet A, Man M, Apoil A (1995) Acromioclavicular dislocations: treatment by coracoacromial ligamentoplasty. J Shoulder Elbow Surg 4(2):130–134
  11. Kraus N, Scheibel M (2014) Verletzungen des Schultereckgelenks bei Sportlern. Chirurg 85(10):854–863. https://doi.org/10.1007/s00104-014-2770-6
  12. Smith TO, Chester R, Pearse EO, Hing CB (2011) Operative versus non-operative management following Rockwood grade III acromioclavicular separation: a meta-analysis of the current evidence base. J Orthopaed Traumatol 12(1):19–27. https://doi.org/10.1007/s10195-011-0127-1
  13. Mouhsine E, Garofalo R, Crevoisier X, Farron A (2003) Grade I and II acromioclavicular dislocations: results of conservative treatment. J Shoulder Elbow Surg 12(6):599–602
  14. Gumina S, Carbone S, Postacchini F (2009) Scapular dyskinesis and SICK scapula syndrome in patients with chronic type III acromioclavicular dislocation. Arthroscopy 25(1):40–45
  15. Shaw MBK, McInerney JJ, Dias JJ, Evans PA (2003) Acromioclavicular joint sprains: the post-injury recovery interval. Injury 34(6):438–442
  16. Mouhsine E, Garofalo R, Crevoisier X, Farron A (2003) Grade I and II acromioclavicular dislocations: results of conservative treatment. J Shoulder Elbow Surg 12(6):599–602
  17. Korsten K, Gunning AC, Leenen LPH (2014) Operative or conservative treatment in patients with Rockwood type III acromioclavicular dislocation: a systematic review and update of current literature. International Orthopaedics (SICOT) 38(4):831–838. https://doi.org/10.1007/s00264-013-2143-7
  18. Longo UG, Ciuffreda M, Rizzello G, Mannering N, Maffulli N, Denaro V (2017) Surgical versus conservative management of Type III acromioclavicular dislocation: a systematic review. Br Med Bull 122(1):31–49. https://doi.org/10.1093/bmb/ldx003
  19. Murray IR, Robinson PG, Goudie EB, Duckworth AD, Clark K, Robinson CM (2018) Open reduction and tunneled suspensory device fixation compared with nonoperative treatment for type-III and type-IV acromioclavicular joint dislocations: the ACORN prospective, randomized controlled trial. J Bone Joint Surg 100(22):1912–1918
  20. McKee M, Pelet S (2015) Multicenter randomized clinical trial of nonoperative versus operative treatment of acute acromio-clavicular joint dislocation. J Orthop Trauma 29(11):479–487
  21. Krul KP, Cook JB, Ku J, Cage JM, Bottoni CR, Tokish JM (2015) Successful conservative therapy in rockwood type V acromioclavicular dislocations. Orthop J Sports Med 3(3_suppl):2325967115S0001. https://doi.org/10.1177/2325967115S00017
  22. Minkus M, Hann C, Scheibel M, Kraus N (2017) Quantification of dynamic posterior translation in modified bilateral Alexander views and correlation with clinical and radiological parameters in patients with acute acromioclavicular joint instability. Arch Orthop Trauma Surg 137(6):845–852
  23. Alexander OM (1954) Radiography of the acromioclavicular articulation. Med Radiogr Photogr 30(2):34–39
  24. Tauber M, Koller H, Hitzl W, Resch H (2010) Dynamic radiologic evaluation of horizontal instability in acute acromioclavicular joint dislocations. Am J Sports Med 38(6):1188–1195. https://doi.org/10.1177/0363546510361951
  25. Kraus N, Hann C, Gerhardt C, Scheibel M (2018) Dynamic instability of the acromioclavicular joint: a new classification for acute AC joint separation. Obere Extrem 13(4):279–285. https://doi.org/10.1007/s11678-018-0469-x
  26. Allemann F, Halvachizadeh S, Waldburger M, Schaefer F, Pothmann C, Pape HC et al (2019) Different treatment strategies for acromioclavicular dislocation injuries: a nationwide survey on open/minimally invasive and arthroscopic concepts. Eur J Med Res 24(1):18. https://doi.org/10.1186/s40001-019-0376-7
  27. Martetschläger F, Horan MP, Warth RJ, Millett PJ (2013) Complications after anatomic fixation and reconstruction of the coracoclavicular ligaments. Am J Sports Med 41(12):2896–2903. https://doi.org/10.1177/0363546513502459
  28. Borbas P, Churchill J, Ek ET (2019) Surgical management of chronic high-grade acromioclavicular joint dislocations: a systematic review. J Shoulder Elbow Surg 28(10):2031–2038
  29. Woodmass JM, Esposito JG, Ono Y, Nelson AA, Boorman RS, Thornton GM et al (2015) Complications following arthroscopic fixation of acromioclavicular separations: a systematic review of the literature. Open Access J Sports Med 6:97–107
  30. Jensen G, Katthagen JC, Alvarado LE, Lill H, Voigt C (2014) Has the arthroscopically assisted reduction of acute AC joint separations with the double tight-rope technique advantages over the clavicular hook plate fixation? Knee Surg Sports Traumatol Arthrosc 22(2):422–430. https://doi.org/10.1007/s00167-012-2270-5
  31. Chernchujit B, Tischer T, Imhoff AB (2006) Arthroscopic reconstruction of the acromioclavicular joint disruption: surgical technique and preliminary results. Arch Orthop Trauma Surg 126(9):575–581. https://doi.org/10.1007/s00402-005-0073-6
  32. Larsen E, Bjerg-Nielsen A, Christensen P (1986) Conservative or surgical treatment of acromioclavicular dislocation. A prospective, controlled, randomized study. J Bone Joint Surg Am 68(4):552–555
  33. Mazet RJ (1943) Migration of a Kirschner wire from the shoulder region into the lung. J Bone Joint Surg 25(2):477
  34. Lin H Y, Wong P K, Ho W P, Chuang T Y, Liao Y S, Wong C C (2014) Clavicular hook plate may induce subacromial shoulder impingement and rotator cuff lesion—dynamic sonographic evaluation. J Orthop Surg Res 9(1):6. https://doi.org/10.1186/1749-799X-9-6
  35. Kona J, Bosse MJ, Staeheli JW, Rosseau RL (1990) Type II distal clavicle fractures: a retrospective review of surgical treatment. J Orthop Trauma 4(2):115–120
  36. Flinkkilä T, Ristiniemi J, Hyvönen P, Hämäläinen M (2002) Surgical treatment of unstable fractures of the distal clavicle: a comparative study of Kirschner wire and clavicular hook plate fixation. Acta Orthop Scand 73(1):50–53. https://doi.org/10.1080/000164702317281404
  37. Jari R, Costic RS, Rodosky MW, Debski RE (2004) Biomechanical function of surgical procedures for acromioclavicular joint dislocations. Arthroscopy 20(3):237–245
  38. Pauly S, Kraus N, Greiner S, Scheibel M (2013) Prevalence and pattern of glenohumeral injuries among acute high-grade acromioclavicular joint instabilities. J Shoulder Elbow Surg 22(6):760–766
  39. Scheibel M, Dröschel S, Gerhardt C, Kraus N (2011) Arthroscopically assisted stabilization of acute high-grade acromioclavicular joint separations. Am J Sports Med 39(7):1507–1516. https://doi.org/10.1177/0363546511399379
  40. Rolla PR, Surace MF, Murena L (2004) Arthroscopic treatment of acute acromioclavicular joint dislocation. Arthroscopy 20(6):662–668
  41. Wolf EM, Fragomen AT (2010) Arthroscopic ligament reconstruction in acromioclavicular joint separation: experience & pitfalls. In: Boileau P (Hrsg) Nice shoulder course. Sauramps Médical, Nizza, S 167–175
  42. Jerosch J, Filler T, Peuker E, Greig M, Siewering U (1999) Which stabilization technique corrects anatomy best in patients with AC-separation? Knee Surg Sports Traumatol Arthrosc 7(6):365–372. https://doi.org/10.1007/s001670050182
  43. Breslow MJ, Jazrawi LM, Bernstein AD, Kummer FJ, Rokito AS (2002) Treatment of acromioclavicular joint separation: suture or suture anchors? J Shoulder Elbow Surg 11(3):225–229
  44. Wellmann M, Zantop T, Petersen W (2007) Minimally invasive coracoclavicular ligament augmentation with a flip button/polydioxanone repair for treatment of total acromioclavicular joint dislocation. Arthroscopy 23(10):1132.e1–1132.e5
  45. Salzmann GM, Walz L, Buchmann S, Glabgly P, Venjakob A, Imhoff AB (2010) Arthroscopically assisted 2 bundle anatomical reduction of acute acromioclavicular joint separations. Am J Sports Med 38(6):1179–1187. https://doi.org/10.1177/0363546509355645
  46. Costic RS, Labriola JE, Rodosky MW, Debski RE (2004) Biomechanical rationale for development of anatomical reconstructions of coracoclavicular ligaments after complete acromioclavicular joint dislocations. Am J Sports Med 32(8):1929–1936. https://doi.org/10.1177/0363546504264637
  47. Hann C, Kraus N, Minkus M, Maziak N, Scheibel M (2018) Combined arthroscopically assisted coraco- and acromioclavicular stabilization of acute high-grade acromioclavicular joint separations. Knee Surg Sports Traumatol Arthrosc 26(1):212–220. https://doi.org/10.1007/s00167-017-4643-2
  48. Saier T, Venjakob AJ, Minzlaff P, Föhr P, Lindell F, Imhoff AB et al (2015) Value of additional acromioclavicular cerclage for horizontal stability in complete acromioclavicular separation: a biomechanical study. Knee Surg Sports Traumatol Arthrosc 23(5):1498–1505. https://doi.org/10.1007/s00167-014-2895-7
  49. Minkus M, Maziak N, Moroder P, Scheibel M (2019) Arthroscopic low-profile reconstruction for acute acromioclavicular joint instability. Obere Extrem 14(1):60–65. https://doi.org/10.1007/s11678-019-0506-4
  50. Spiegl UJ, Smith SD, Euler SA, Dornan GJ, Millett PJ, Wijdicks CA (2014) Biomechanical consequences of coracoclavicular reconstruction techniques on clavicle strength. Am J Sports Med 42(7):1724–1730. https://doi.org/10.1177/0363546514524159
  51. Thangaraju S, Cepni S, Magosch P, Tauber M, Habermeyer P, Martetschläger F (2019) Arthroscopically assisted acromioclavicular joint stabilization leads to significant clavicular tunnel widening in the early post-operative period. Knee Surg Sports Traumatol Arthrosc 27(12):3821–3826. https://doi.org/10.1007/s00167-019-05662-5
  52. Bellmann F, Dittrich M, Wirth B, Freislederer F, Scheibel M (2021) Arthroscopically assisted stabilization of chronic acromioclavicular joint instability. JBJS Essent Surg Tech. https://doi.org/10.2106/JBJS.ST.20.00033
  53. Hislop P, Sakata K, Ackland DC, Gotmaker R, Evans MC (2019) Acromioclavicular joint stabilization: a biomechanical study of bidirectional stability and strength. Orthop J Sports Med 7(4):232596711983675. https://doi.org/10.1177/2325967119836751
  54. Tauber M, Gordon K, Koller H, Fox M, Resch H (2009) Semitendinosus tendon graft versus a modified weaver-dunn procedure for acromioclavicular joint reconstruction in chronic cases: prospective comparative study. Am J Sports Med 37(1):181–190. https://doi.org/10.1177/0363546508323255
  55. Hosseini H, Friedmann S, Tröger M, Lobenhoffer P, Agneskirchner JD (2009) Arthroscopic reconstruction of chronic AC joint dislocations by transposition of the coracoacromial ligament augmented by the Tight Rope device: a technical note. Knee Surg Sports Traumatol Arthrosc 17(1):92–97. https://doi.org/10.1007/s00167-008-0633-8
  56. Grutter PW, Petersen SA (2005) Anatomical acromioclavicular ligament reconstruction: a biomechanical comparison of reconstructive techniques of the acromioclavicular joint. Am J Sports Med 33(11):1723–1728. https://doi.org/10.1177/0363546505275646
  57. Fauci F, Merolla G, Paladini P, Campi F, Porcellini G (2013) Surgical treatment of chronic acromioclavicular dislocation with biologic graft vs synthetic ligament: a prospective randomized comparative study. J Orthopaed Traumatol 14(4):283–290. https://doi.org/10.1007/s10195-013-0242-2
  58. Cook JB, Shaha JS, Rowles DJ, Bottoni CR, Shaha SH, Tokish JM (2012) Early failures with single clavicular transosseous coracoclavicular ligament reconstruction. J Shoulder Elbow Surg 21(12):1746–1752
  59. Milewski MD, Tompkins M, Giugale JM, Carson EW, Miller MD, Diduch DR (2012) Complications related to anatomic reconstruction of the coracoclavicular ligaments. Am J Sports Med 40(7):1628–1634. https://doi.org/10.1177/0363546512445273
  60. Kraus N, Hann C, Minkus M, Maziak N, Scheibel M (2019) Primary versus revision arthroscopically-assisted acromio- and coracoclavicular stabilization of chronic AC-joint instability. Arch Orthop Trauma Surg 139(8):1101–1109. https://doi.org/10.1007/s00402-019-03153-3
  61. Dittrich M, Wirth B, Freislederer F, Bellmann F, Scheibel M (2020) Arthroscopically assisted stabilization of chronic bidirectional acromioclavicular joint instability using a low-profile implant and a free tendon graft: A technical note. Obere Extrem 15(2):118–121. https://doi.org/10.1007/s11678-020-00576-y