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Aktuelle Aspekte und neue Techniken bei Schultereckgelenksprengung

Current aspects and new techniques in dislocation of the shoulder joint

Zusammenfassung

Die Verletzung des Akromioklavikulargelenks ist v. a. bei jungen und sportlichen Patienten eine häufige Verletzung des Schultergürtels und macht etwa 12 % der Schulterverletzungen aus. Die heute weitverbreitetste Einteilung ist die Klassifikation nach Rockwood, die 6 Typen abhängig vom Grad der Verletzung sowie von der vertikalen Dislokation unterscheidet. Da die horizontale Instabilität in dieser Klassifikation nicht entsprechend berücksichtigt wird, ist der Nutzen infrage gestellt. Während Typ-I- und Typ-II-Luxationen grundsätzlich konservativ und Typ-IV- bis Typ-VI-Luxationen operativ versorgt werden sollten, ist die Literatur bezüglich der Rockwood-Typ-III-Luxationen nicht konklusiv. Aus diesem Grund sind Einteilung sowie Therapie dieser Verletzungen vermehrt Gegenstand wissenschaftlicher Untersuchungen und Diskussionen, wobei aktuell noch kein Konsens besteht. Dieser Übersichtsbeitrag legt die heutige Evidenz für die Diagnostik, verschiedene Klassifikationen und die therapeutischen Möglichkeiten dar.

Abstract

With 12% of all injuries concerning the shoulder, acromioclavicular (AC) joint dislocations are a common injury especially in young and active patients. The Rockwood classification is widely accepted, which differentiates between six types depending on the degree of injury and the vertical dislocation. Because the classification does not adequately address the horizontal instability, its benefits are questionable and there is currently no consensus. For this reason, the classification and the therapy of these injuries are increasingly becoming the subject of scientific investigations. Whereas conservative treatment for type I and II injuries and operative treatment for type IV–VI injuries are widely accepted, there is still no agreement in treating type III lesions. The goal of this review article is to present the current evidence for the diagnostics, different classifications and therapeutic possibilities.

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Abbreviations

AC-DC:

Acromion center to distal clavicle

AC:

Akromioklavikular

ACJI:

Acromioclavicular joint instability

BIPOD:

Bipodale Fixationstechnik in vertikaler und horizontaler Richtung nach Akromioklavikulargelenksluxation

CC-Bänder:

Korakoklavikuläre Bänder

CC-Distanz:

Distanz zwischen Korakoid und Klavikula

CT:

Computertomographie

GACA:

Gleno-acromio-clavicular angle

GC-PC:

Glenoid centre to posterior clavicle

ISAKOS:

International Society of Arthroscopy, Knee Surgery and Orthopaedic Sports Medicine

K-Draht:

Kirschner-Draht

MRI:

Magnetic resonance imaging

SLAP:

Superior labrum anterior posterior

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Correspondence to M. A. Zumstein.

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J. Abel, M.A. Zumstein, L. Bolliger und M.O. Schär geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren. Alle Patienten, die über Bildmaterial oder anderweitige Angaben innerhalb des Manuskripts zu identifizieren sind, haben hierzu ihre schriftliche Einwilligung gegeben. Im Falle von nicht mündigen Patienten liegt die Einwilligung eines Erziehungsberechtigten oder des gesetzlich bestellten Betreuers vor.

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Abel, J., Zumstein, M.A., Bolliger, L. et al. Aktuelle Aspekte und neue Techniken bei Schultereckgelenksprengung. Orthopäde 47, 158–167 (2018). https://doi.org/10.1007/s00132-017-3517-0

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Schlüsselwörter

  • Akromioklavikulargelenk
  • Rockwood-Klassifikation
  • Luxation
  • Instabilität
  • Hakenplatte
  • TightRope
  • Bipod

Keywords

  • Acromioclavicular joint
  • Rockwood classification
  • Dislocation
  • Instability
  • Hook plate
  • TightRope
  • Bipod