nach oben

Erschienen in:

28.04.2017 | Original Paper

Concomitant glenohumeral pathologies associated with acute and chronic grade III and grade V acromioclavicular joint injuries

verfasst von: Gunnar Jensen, Peter J. Millett, Dimitri S. Tahal, Mireille Al Ibadi, Helmut Lill, Jan Christoph Katthagen

Erschienen in: International Orthopaedics | Ausgabe 8/2017

Einloggen, um Zugang zu erhalten

Abstract

Purpose

The purpose of this study was to identify the risk of concomitant glenohumeral pathologies with acromioclavicular joint injuries grade III and V.

Methods

Patients who underwent arthroscopically-assisted stabilization of acromioclavicular joint injuries grade III or grade V between 01/2007 and 12/2015 were identified in the patient databases of two surgical centres. Gender, age at index surgery, grade of acromioclavicular joint injury (Rockwood III or Rockwood V), and duration between injury and index surgery (classified as acute or chronic) were of interest. Concomitant glenohumeral pathologies were noted and their treatment was classified as debridement or reconstructive procedure.

Results

A total of 376 patients (336 male, 40 female) were included. Mean age at time of arthroscopic acromioclavicular joint reconstruction surgery was 42.1 ± 14.0 years. Overall, 201 patients (53%) had one or more concomitant glenohumeral pathologies. Lesions of the biceps tendon complex and rotator cuff were the most common. Forty-five patients (12.0%) had concomitant glenohumeral pathologies that required an additional repair. The remaining 156 patients (41.5%) received a debridement of their concomitant pathologies. Rockwood grade V compared to Rockwood grade III (p = 0.013; odds ratio 1.7), and chronic compared to acute injury were significantly associated with having a concomitant glenohumeral pathology (p = 0.019; odds ratio 1.7). The probability of having a concomitant glenohumeral pathology was also significantly associated with increasing age (p < 0.0001).

Conclusions

Concomitant glenohumeral pathologies were observed in 53% of surgically treated patients with an acute or chronic acromioclavicular joint injury of either grade III or V. Twenty-two percent of these patients with concomitant glenohumeral pathologies received an additional dedicated repair procedure. Although a significant difference in occurrence of concomitant glenohumeral pathologies was seen between Rockwood grades III and V, and between acute and chronic lesions, increasing age was identified as the most dominant predictor.

Level of Evidence: Level IV, case series.

Chillemi C, Franceschini V, Dei Giudici L et al (2013) Epidemiology of isolated acromioclavicular joint dislocations. Emerg Med Int 2013:171609CrossRefPubMedPubMedCentral

Pallis M, Cameron KL, Svoboda SJ, Owens BD (2012) Epidemiology of acromioclavicular joint injury in young athletes. Am J Sports Med 40(9):2072–2077CrossRefPubMed

Lynch TS, Saltzman MD, Ghodasra JH, Bilimoria KY, Bowen MK, Nuber GW (2013) Acromioclavicular joint injuries in the National Football League: epidemiology and management. Am J Sports Med 41(12):2904–2908CrossRefPubMed

Rockwood C (1984) Injuries in the acromioclavicular joint: subluxations and dislocations about the shoulder. In: Rockwood CA Jr, Green D (eds) Fracture in adults. Lippincott, Philadelphia, pp 890–910

Beitzel K, Mazzocca AD, Bak K et al (2014) ISAKOS upper extremity committee consensus statement on the need for diversification of the Rockwood classification for acromioclavicular joint injuries. Arthroscopy 30(2):271–278CrossRefPubMed

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. Int Orthop 38(4):831–838CrossRefPubMed

Modi CS, Beazley J, Zywiel MG, Lawrence TM, Veillette CJ (2013) Controversies relating to the management of acromioclavicular joint dislocations. Bone Joint 95-B(12):1595–1602CrossRef

Petri M, Warth RJ, Greenspoon JA, Horan MP, Abrams RF, Kokmeyer D, Millett PJ (2016) Clinical results after conservative Management for Grade III acromioclavicular joint injuries: does eventual surgery affect overall outcomes? Arthroscopy 32(5):740–746CrossRefPubMed

Tauber M (2013) Management of acute acromioclavicular joint dislocations: current concepts. Arch Orthop Trauma Surg 133(7):985–995

10.

Warth RJ, Martetschlager F, Gaskill TR, Millett PJ (2013) Acromioclavicular joint separations. Curr Rev Musculoskelet Med 6(1):71–78CrossRefPubMed

11.

De Carli A, Lanzetti RM, Ciompi A, Lupariello D, Rota P, Ferretti A (2015) Acromioclavicular third degree dislocation: surgical treatment in acute cases. J Orthop Surg Res 10:13CrossRefPubMedPubMedCentral

12.

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

13.

Millett PJ, Horan MP, Warth RJ (2015) Two-year outcomes after primary anatomic coracoclavicular ligament reconstruction. Arthroscopy 31(10):1962–1973CrossRefPubMed

14.

Natera-Cisneros L, Sarasquete-Reiriz J, Escola-Benet A, Rodriguez-Miralles J (2015) Acute high-grade acromioclavicular joint injuries treatment: arthroscopic non-rigid coracoclavicular fixation provides better quality of life outcomes than hook plate ORIF. Orthop Trauma Surg Res 102(1):31–39CrossRef

15.

Rasmont Q, Delloye C, Bigare E, Isacker TV (2015) Is conservative treatment still defensible in grade III acromioclavicular dislocation? Are there predictive factors of poor outcome? Acta Orthop Belg 81(1):107–114PubMed

16.

Rosslenbroich SB, Schliemann B, Schneider KN et al (2015) Minimally invasive coracoclavicular ligament reconstruction with a flip-button technique (MINAR): clinical and radiological midterm results. Am J Sports Med 43(7):1751–1757CrossRefPubMed

17.

Jensen G, Katthagen JC, Alvarado L, Lill H, Voigt C (2013) Arthroscopically assisted stabilization of chronic AC-joint instabilities in GraftRope™ technique with an additive horizontal tendon augmentation. Arch Orthop Trauma Surg 133(6):841–851CrossRefPubMed

18.

Lorbach O, Trennheuser C, Anagnostakos K (2014) Diagnostic and therapy of isolated lesions of the proximal biceps. Obere Extrem 9:10–16CrossRef

19.

Pauly S, Gerhardt C, Haas NP, Scheibel M (2009) Prevalence of concomitant intraarticular lesions in patients treated operatively for high-grade acromioclavicular joint separations. Knee Surg Sports Traumatol Arthrosc 17(5):513–517CrossRefPubMed

20.

Pauly S, Kraus N, Greiner S, Scheibel M (2013) Prevalence and pattern of glenohumeral injuries among acute high-grade acromioclavicular joint instabilities. J Shoulder Elb Surg 22(6):760–766CrossRef

21.

Tauber M, Valler D, Lichtenberg S, Magosch P, Moroder P, Habermeyer P (2016) Arthroscopic stabilization of chronic acromioclavicular joint dislocations: triple-versus single-bundle reconstruction. Am J Sports Med 44(2):482–489CrossRefPubMed

22.

Beitzel K, Obopilwe E, Apostolakos K et al (2014) Rotational and translational stability of different methods for direct acromioclavicular ligament repair in anatomic acromioclavicular joint reconstruction. Am J Sports Med 42(9):2141–2148CrossRefPubMed

23.

Arrigoni P, Brady PC, Zottarelli L et al (2014) Associated lesions requiring additional surgical treatment in grade 3 acromioclavicular joint dislocations. Arthroscopy 30(1):6–10CrossRefPubMed

24.

Tischer T, Salzmann GM, El-Azab H, Vogt S, Imhoff AB (2009) Incidence of associated injuries with acute acromioclavicular joint dislocations types III through V. Am J Sports Med 37(1):136–139CrossRefPubMed

25.

Flint JH, Wade AM, Giuliani J, Rue JP (2014) Defining the terms acute and chronic in orthopaedic sports injuries: a systematic review. Am J Sports Med 42(1):235–241CrossRefPubMed

26.

Snyder SJ, Karzel RP, Del Pizzo W, Ferkel RD, Friedman MJ (1990) SLAP lesions of the shoulder. Arthroscopy 6(4):274–279CrossRefPubMed

27.

R Core Team (2015) R: A language and environment for statistical computing. R foundation for statistical computing, Vienna

28.

Momenzadeh OR, Gerami MH, Sefidbakht S, Dehghani S (2015) Assessement of correlation between MRI and arthroscopic pathologic findings in the shoulder joint. Arch Bone Jt Surg 3(4):286–290PubMedPubMedCentral

29.

Alyas F, Curtis M, Speed C, Saifuddin A, Connell D (2008) MR imaging appearances of acromioclavicular joint dislocation. Radiographics 28(2):463–479CrossRefPubMed

30.

Izadpanah K, Winterer J, Vicari M et al (2013) A stress MRI of the shoulder for evaluation of ligamentous stabilizers in acute and chronic acromioclavicular joint instabilities. J Magn Reson Imaging 37(6):1486–1492CrossRefPubMed

31.

Nemec U, Oberleitner G, Nemec SF et al (2011) MRI versus radiography of acromioclavicular joint dislocation. AJR Am J Roentgenol 197(4):968–973CrossRefPubMed

32.

Jensen G, Ellwein A, Voigt C, Katthagen JC, Lill H (2015) [Injuries of the acromioclavicular joint: hook plate versus arthroscopy]. Unfallchirurg 118(12):1041-1055 (in German)

33.

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):2896–2903CrossRefPubMed

34.

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):1724–1730CrossRefPubMed

35.

Gille J, Heinrichs G, Unger A, Riepenhof H, Herzog J, Kienast B, Oheim R (2013) Arthroscopic-assisted hook plate fixation for acromioclavicular joint dislocation. Int Orthop 37(1):77–82CrossRefPubMed

36.

Gill TK, Shanahan EM, Allison D, Alcorn D, Hill CL (2014) Prevalence of abnormalities on shoulder MRI in symptomatic and asymptomatic older adults. Int J Rheum Dis 17(8):863–871CrossRefPubMed

37.

Mall NA, Kim HM, Keener JD et al (2010) Symptomatic progression of asymptomatic rotator cuff tears: a prospective study of clinical and sonographic variables. J Bone Joint Surg Am 92(16):2623–2633CrossRefPubMedPubMedCentral

38.

Maman E, Harris C, White L, Tomlinson G, Shashank M, Boyton E (2009) Outcome of nonoperative treatment of symptomatic rotator cuff tears monitored by magnetic resonance imaging. J Bone Joint Surg Am 91(8):1898–1906CrossRefPubMed

39.

Moosmayer S, Tarig R, Smith HJ (2013) The natural history of asymptomatic rotator cuff tears: a three-year follow-up of fifty cases. J Bone Joint Surg Am 95(14):1249–1255CrossRefPubMed

40.

Kibler WB, Sciascia A, (2016) The role of the scapula in preventing and treating shoulder instability. Knee Surg Sports Traumatol Arthrosc 24(2):390-397

41.

Ludewig PM, Reynolds JF (2009) The association of scapular kinematics and glenohumeral joint pathologies. J Orthop Sports Phys Ther 39(2):90–104CrossRefPubMedPubMedCentral

42.

Nowotny J, Kopkow C, Mauch F, Kasten P (2016) Effective rehabilitation in patients with scapular dyskinesis. Obere Extrem 11(1):40–46CrossRef

43.

Osti L, Del Buono A, Maffulli N (2013) Microfractures at the rotator cuff footprint: a randomized controlled study. Int Orthop 37(11):2165–2171CrossRefPubMedPubMedCentral

Titel: Concomitant glenohumeral pathologies associated with acute and chronic grade III and grade V acromioclavicular joint injuries
verfasst von: Gunnar Jensen
Peter J. Millett
Dimitri S. Tahal
Mireille Al Ibadi
Helmut Lill
Jan Christoph Katthagen
Publikationsdatum: 28.04.2017
Verlag: Springer Berlin Heidelberg
Erschienen in: International Orthopaedics / Ausgabe 8/2017
Print ISSN: 0341-2695
Elektronische ISSN: 1432-5195
DOI: https://doi.org/10.1007/s00264-017-3469-3

Arthropedia

Grundlagenwissen der Arthroskopie und Gelenkchirurgie. Erweitert durch Fallbeispiele, Videos und Abbildungen.
» Jetzt entdecken

Neu im Fachgebiet Orthopädie und Unfallchirurgie

Knie-TEP: Kein Vorteil durch antibiotikahaltigen Knochenzement

29.05.2024 Periprothetische Infektionen Nachrichten

Zur Zementierung einer Knie-TEP wird in Deutschland zu über 98% Knochenzement verwendet, der mit einem Antibiotikum beladen ist. Ob er wirklich besser ist als Zement ohne Antibiotikum, kann laut Registerdaten bezweifelt werden.

Häusliche Gewalt in der orthopädischen Notaufnahme oft nicht erkannt

28.05.2024 Häusliche Gewalt Nachrichten

In der Notaufnahme wird die Chance, Opfer von häuslicher Gewalt zu identifizieren, von Orthopäden und Orthopädinnen offenbar zu wenig genutzt. Darauf deuten die Ergebnisse einer Fragebogenstudie an der Sahlgrenska-Universität in Schweden hin.

Fehlerkultur in der Medizin – Offenheit zählt!

28.05.2024 Fehlerkultur Podcast

Darüber reden und aus Fehlern lernen, sollte das Motto in der Medizin lauten. Und zwar nicht nur im Sinne der Patientensicherheit. Eine negative Fehlerkultur kann auch die Behandelnden ernsthaft krank machen, warnt Prof. Dr. Reinhard Strametz. Ein Plädoyer und ein Leitfaden für den offenen Umgang mit kritischen Ereignissen in Medizin und Pflege.

Mehr Frauen im OP – weniger postoperative Komplikationen

21.05.2024 Allgemeine Chirurgie Nachrichten

Ein Frauenanteil von mindestens einem Drittel im ärztlichen Op.-Team war in einer großen retrospektiven Studie aus Kanada mit einer signifikanten Reduktion der postoperativen Morbidität assoziiert.

Update Orthopädie und Unfallchirurgie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

Newsletter bestellen

Live-Webinar "Urologie und Sexualmedizin in der Praxis"

Springer Medizin

Concomitant glenohumeral pathologies associated with acute and chronic grade III and grade V acromioclavicular joint injuries