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Epidemiologie, Anatomie, Biomechanik und Bildgebung von Akromioklavikulargelenkverletzungen

Epidemiology, anatomy, biomechanics and imaging of acromioclavicular joint injuries

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Zusammenfassung

Aktuelle Techniken der Akromioklavikulargelenkstabilisierung adressieren primär oder isoliert einen Ersatz der korakoklavikulären Bänder. Inwiefern dieses Vorgehen jedoch geeignet ist, neben der vertikalen Primärstabilität auch die Kinematik und Stabilität des Gelenks in der horizontalen Ebene wiederherzustellen, ist fraglich.

In der vorliegenden Arbeit werden die Epidemiologie und die Koinzidenz von intraartikulären Begleitverletzungen behandelt. Des Weiteren wird die für die operative Praxis essentielle Anatomie der CC-Bänder und die Pathomechanik von AC-Gelenkverletzungen beschrieben. Zudem werden aktuelle propagierte Techniken zur AC-Gelenkstabilisierung einer kritischen Würdigung unter biomechanischen Aspekten unterzogen. Dabei zeigt sich, dass weder isolierte korakoklavikuläre (CC-) noch isolierte akromioklavikuläre (AC-)Rekonstruktionen in der Lage sind, sowohl die Vertikal- als auch die Horizontalstabilität des AC-Gelenks wiederherzustellen. Als klinische Konsequenz ist daher neben einer detaillierten radiologischen Diagnostik der AC-Gelenkverletzungen, wie sie im Artikel beschrieben wird, eine an das Instabilitätsmuster angepasste operative Therapie zu fordern.

Abstract

Current techniques of acromioclavicular (AC) joint repair primarily focus on the reconstruction of the coracoclavicular (CC) ligaments. However, it is not clear if this approach is sufficient to restore vertical as well as horizontal AC joint stability and kinematics. This review focuses on the epidemiology of AC joint injuries and the coincidence of intra-articular pathologies. Furthermore, the clinically relevant anatomy and the pathomechanism of AC joint instability are described. The biomechanical characteristics of current procedures as they have been revealed by in vitro investigations are summarized. As a basic result, neither selective repair of the CC ligaments nor selective repair of the AC ligaments could be shown to restore both vertical and horizontal joint stability. Similar to the intact ligaments CC repair primarily provides vertical joint stability while AC repair is able to restore horizontal stability.

In conclusion a biomechanically effective treatment of AC joint separation should analyze the individual instability pattern in the first step. Therefore, the radiological standard according to Rockwood should be supplemented by specific stress x-rays for quantification of dynamic horizontal AC joint instability. In the second step an adequate surgical treatment considering CC and AC stabilization should be performed meeting the individual patient requirements.

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  1. Klinik für Orthopädie, Medizinischen Hochschule Hannover im Annastift, Anna von Borries Straße 1–6, 30625, Hannover, Deutschland

    M. Wellmann &  T. Smith

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  1. M. Wellmann
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  2. T. Smith
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Correspondence to T. Smith.

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Wellmann, M., Smith, T. Epidemiologie, Anatomie, Biomechanik und Bildgebung von Akromioklavikulargelenkverletzungen. Unfallchirurg 115, 867–871 (2012). https://doi.org/10.1007/s00113-012-2247-3

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