Advertisement

Arthroskopie

, Volume 32, Issue 1, pp 11–14 | Cite as

Innovationen bei der Therapie von Instabilitäten des Akromioklavikulargelenks

  • D. Berthold
  • F. Dyrna
  • A. B. Imhoff
  • F. MartetschlägerEmail author
Leitthema
  • 136 Downloads

Zusammenfassung

Die operative Versorgung der Instabilität des Akromioklavikulargelenks (ACG) bleibt den kombinierten horizontalen und vertikalen Instabilitäten vorbehalten. Akute ACG-Luxationen sollten innerhalb von 2 bis 3 Wochen nach dem initialen Trauma operativ versorgt werden. Ziel ist die anatomische Reposition und Stabilisierung des ACG in der vertikalen und horizontalen Ebene. Die Kombination aus Rekonstruktionen des korakoklavikulären (CC) Bands durch Doppelbutton-Fadensysteme und additiven transakromialen Fadencerclagen ist zu favorisieren. Chronische ACG-Luxationen benötigen neben der anatomischen Reposition und primären Stabilisierung eine biologische Augmentation mit Sehnentransplantat. Auch hier sind Techniken zur gleichzeitigen AC- und CC-Stabilisierung beschrieben.

Schlüsselwörter

AC-Gelenk Akromioklavikulargelenk Instabilität Korakoklavikuläre Bänder Sehnenaugmentation 

Innovations for treatment of acromioclavicular joint instability

Abstract

Even with ongoing research and surgical innovations no gold standard for the treatment of disruption of the acromioclavicular (AC) joint exists; however, surgical intervention is recommended if a combination of horizontal and vertical instability is present. Acute high-grade AC joint luxation should be treated within 2–3 weeks after the initial trauma. Surgeons should aim for an anatomical repositioning and stabilization in the vertical and horizontal planes. Therefore, the combination of coracoclavicular (CC) ligament reconstruction using double-button suture constructs and additional transacromial suture cerclage is recommended. For chronic AC joint luxation a biological augmentation with a free tendon graft is mandatory in addition to anatomical repositioning and primary stabilization. Several arthroscopically assisted and open techniques have been described for simultaneous AC and CC stabilization.

Keywords

AC joint Acromioclavicular joint Instability Coracoclavicular ligaments Tendon augmentation 

Notes

Einhaltung ethischer Richtlinien

Interessenkonflikt

D. Berthold, F. Dyrna, A.B. Imhoff und F. Martetschläger geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

Literatur

  1. 1.
    Banffy MB, Uquillas C, Neumann JA, ElAttrache NS (2018) Biomechanical evaluation of a single- versus double-tunnel coracoclavicular ligament reconstruction with acromioclavicular stabilization for acromioclavicular joint injuries. Am J Sports Med 46:1070–1076.  https://doi.org/10.1177/0363546517752673 CrossRefPubMedGoogle Scholar
  2. 2.
    Barth J, Duparc F, Andrieu K et al (2015) Is coracoclavicular stabilisation alone sufficient for the endoscopic treatment of severe acromioclavicular joint dislocation (Rockwood types III, IV, and V)? Orthop Traumatol Surg Res 101:S297–S303.  https://doi.org/10.1016/j.otsr.2015.09.003 CrossRefPubMedGoogle Scholar
  3. 3.
    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 30:271–278CrossRefGoogle Scholar
  4. 4.
    Braun S, Imhoff AB, Martetschläger F (2015) Arthroscopically assisted techniques for treatment of acute and chronic acromioclavicular joint injuries. Unfallchirurg 118:407–414.  https://doi.org/10.1007/s00113-015-0004-0 CrossRefPubMedGoogle Scholar
  5. 5.
    Braun S, Martetschläger F, Imhoff AB (2014) Arthroscopically assisted reconstruction of acute and chronic AC joint separations. Oper Orthop Traumatol 26:228–236.  https://doi.org/10.1007/s00064-013-0276-x CrossRefPubMedGoogle Scholar
  6. 6.
    Dyrna F, de Oliveira CCT, Nowak M et al (2018) Risk of fracture of the acromion depends on size and orientation of acromial bone tunnels when performing acromioclavicular reconstruction. Knee Surg Sports Traumatol Arthrosc 26:275–284.  https://doi.org/10.1007/s00167-017-4728-y CrossRefPubMedGoogle Scholar
  7. 7.
    Dyrna FGE, Imhoff FB, Voss A et al (2018) The integrity of the acromioclavicular capsule ensures physiological centering of the acromioclavicular joint under rotational loading. Am J Sports Med 46:1432–1440.  https://doi.org/10.1177/0363546518758287 CrossRefPubMedGoogle Scholar
  8. 8.
    Flint JH, Wade AM, Giuliani J, Rue J‑P (2014) Defining the terms acute and chronic in orthopaedic sports injuries: a systematic review. Am J Sports Med 42:235–241.  https://doi.org/10.1177/0363546513490656 CrossRefPubMedGoogle Scholar
  9. 9.
    Martetschläger F, Horan MP, Warth RJ, Millett PJ (2013) Complications after anatomic fixation and reconstruction of the coracoclavicular ligaments. Am J Sports Med 41:2896–2903.  https://doi.org/10.1177/0363546513502459 CrossRefPubMedGoogle Scholar
  10. 10.
    Martetschläger F, Saier T, Weigert A et al (2016) Effect of coracoid drilling for acromioclavicular joint reconstruction techniques on coracoid fracture risk: a biomechanical study. Arthroscopy.  https://doi.org/10.1016/j.arthro.2015.11.049 CrossRefPubMedGoogle Scholar
  11. 11.
    Martetschläger F, Tauber M, Habermeyer P, Hawi N (2016) Arthroscopically assisted acromioclavicular and coracoclavicular ligament reconstruction for chronic acromioclavicular joint instability. Arthrosc Tech 5:e1239–e1246.  https://doi.org/10.1016/j.eats.2016.07.014 CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Saier T, Venjakob AJ, Minzlaff P et al (2015) Value of additional acromioclavicular cerclage for horizontal stability in complete acromioclavicular separation: a biomechanical study. Knee Surg Sports Traumatol Arthrosc 23:1–8.  https://doi.org/10.1007/s00167-014-2895-7 CrossRefGoogle Scholar
  13. 13.
    Song T, Yan X, Ye T (2014) Comparison of the outcome of early and delayed surgical treatment of complete acromioclavicular joint dislocation. Knee Surg Sports Traumatol Arthrosc.  https://doi.org/10.1007/s00167-014-3225-9 CrossRefPubMedGoogle Scholar
  14. 14.
    Stein T, Müller D, Blank M et al (2018) Stabilization of acute high-grade acromioclavicular joint separation: a prospective assessment of the clavicular hook plate versus the double double-button suture procedure. Am J Sports Med 18:363546518788355.  https://doi.org/10.1177/0363546518788355 CrossRefGoogle Scholar
  15. 15.
    Tauber M, Valler D, Lichtenberg S et al (2016) Arthroscopic stabilization of chronic acromioclavicular joint dislocations: triple- versus single-bundle reconstruction. Am J Sports Med 44:482–489.  https://doi.org/10.1177/0363546515615583 CrossRefPubMedGoogle Scholar
  16. 16.
    Woodmass JM, Esposito JG, Ono Y et al (2015) Complications following arthroscopic fixation of acromioclavicular separations: a systematic review of the literature. Open Access J Sports Med 6:97–107.  https://doi.org/10.2147/OAJSM.S73211 CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    Zumstein MA, Schiessl P, Ambuehl B et al (2018) New quantitative radiographic parameters for vertical and horizontal instability in acromioclavicular joint dislocations. Knee Surg Sports Traumatol Arthrosc 26:125–135.  https://doi.org/10.1007/s00167-017-4579-6 CrossRefPubMedGoogle Scholar

Copyright information

© Springer Medizin Verlag GmbH, ein Teil von Springer Nature 2018

Authors and Affiliations

  • D. Berthold
    • 1
  • F. Dyrna
    • 1
  • A. B. Imhoff
    • 1
  • F. Martetschläger
    • 2
    Email author
  1. 1.Abteilung für SportorthopädieKlinikum rechts der IsarMünchenDeutschland
  2. 2.Deutsches SchulterzentrumATOS Klinik MünchenMünchenDeutschland

Personalised recommendations