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Arthroskopischer Korakoidtransfer

Indikation, Technik und mittelfristige Ergebnisse

Arthroscopic coracoid transfer

Indications, technique and mid-term results

  • Leitthema: Originalarbeit
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Obere Extremität Aims and scope Submit manuscript

Zusammenfassung

Hintergrund

Die operative Standardversorgung der vorderen Schulterinstabilität ist die Kapsel-Labrum-Refixation an das ventrale Glenoid (Bankart-Refixation). Bei relevanten Knochendefekten am Glenoid oder komplexen Weichteilläsionen bietet der Korakoidtransfer nach Latarjet eine stabilere Versorgungsoption – jedoch ist er bislang nur wenig verbreitet. Im Vergleich zum offenen Vorgehen lässt sich das Auftreten arthrotischer Langzeitfolgen noch nicht abschließend beurteilen. Die mittelfristigen Ergebnisse sind jedoch ermutigend.

Fragestellung

Anhand einer Fallserie von Patienten mit arthroskopischer Latarjet-Operation werden Patientenzufriedenheit, Funktion, Stabilität und die Komplikationsrate ermittelt.

Methoden

Seit 2007 wurden 221 Patienten mit einem arthroskopischen Korakoidtransfer therapiert. Davon waren 192 Patienten bereits voroperiert (Bankart) und 101 Patienten bereits 2-mal oder öfter voroperiert. Die Komplikationsrate wurde für alle Patienten erfasst. Aus dem Gesamtkollektiv wurden 50 Patienten (Operation zwischen 2007 und 2010) nach einem mittleren Zeitraum von 4,5 Jahren klinisch und radiologisch nachuntersucht.

Ergebnisse

Auf der visuellen Analogskala waren die Patienten mit einem Wert von 8,8 von 10 mit der Operation sehr zufrieden. Die Stabilität wurde mit 7,6 von 10 beurteilt. Der Walch-Duplay-Score stieg im Mittel von 48 auf 86 an. Der Oxford-Shoulder-Score war bei der Nachuntersuchung bei 94 % der Fälle sehr gut oder gut. Bei der radiologischen Nachuntersuchung ließ sich regelhaft ein Remodeling des Korakoids nachweisen, welches ohne Zusammenhang zum klinischen Ergebnis blieb. Bei 11 von 221 (5 %) Patienten erfolgte auf Grund von Komplikationen eine Revision.

Schlussfolgerungen

Patienten mit vorderer Schulterinstabilität bei Glenoidknochenverlust oder irreparablem Weichteildefekt können durch einen arthroskopischen Korakoidtransfer nach Latarjet sicher und mit hoher Patientenzufriedenheit minimal-invasiv stabilisiert werden. Die Komplikationsrate der häufig voroperierten Patienten war relativ gering.

Abstract

Background

The standard operative treatment of anterior shoulder instability is refixation of the capsule and labrum to the anterior glenoid (Bankart repair). In cases of larger bony defects or complex soft-tissue lesions coracoid transfer (Latarjet procedure) provides a more stable treatment option. The arthroscopic coracoid transfer is not frequently performed because of the high technical demands and possible neurovascular complications. Compared to the open Latarjet procedure the risk of long-term arthritic consequences cannot yet be rated but mid-term results are promising.

Objectives

Based on a clinical case series of patients treated by an arthroscopic Latarjet operation the results concerning stability, function, complication rate and patient satisfaction were assessed.

Methods

Since 2007 a total of 221 patients were treated with an arthroscopic coracoid transfer and any complications needing revision surgery were recorded. Clinical and radiological follow-up were assessed for 50 patients (surgery between 2007 and 2010) after a mean of 4.5 years.

Results

On the visual analogue scale the patients were very satisfied with the operation (8.8 out of 10) and the stability was rated with 7.6 out of 10. The mean Walch Duplay score increased from 48 to 86. The Oxford shoulder score was very good or good in 94 % of the patients at follow-up. The radiological evaluation generally showed a remodeling of the coracoid graft which did not affect the clinical result and so far11 out of 221 (5 %) patients needed further revision surgery.

Conclusion

Patients with anterior shoulder instability and glenoid bone loss or irreparable soft tissue lesions can be successfully treated with a minimally invasive arthroscopic coracoid transfer according to Latarjet with a high degree of patient satisfaction. The risk of complications is relatively low although the follow-up period included the learning curve of this technically very demanding procedure and given the high number of patients with failed previous surgery included in the study.

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Einhaltung ethischer Richtlinien

Interessenkonflikt. Dr J.D. Agneskirchner hat einen Beratervertrag mit Depuy Mitek. M. Holschen, S. Dugaro und J.D. Agneskirchner geben an, dass kein Interessenkonflikt besteht.

Über einen mittleren Zeitraum von 4,5 Jahren (mindestens 3 Jahre) wurden 50 Patienten nachuntersucht. Ein Ethikvotum der medizinischen Hochschule Hannover für die Nachuntersuchung lag vor.

Von allen Patienten liegt eine Einverständniserklärung vor.

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Authors and Affiliations

  1. Sportsclinic Germany, Uhlemeyerstrasse 16, 30175, Hannover, Deutschland

    Malte Holschen, Sebastian Dugaro &  Jens D. Agneskirchner

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  1. Malte Holschen
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  2. Sebastian Dugaro
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  3. Jens D. Agneskirchner
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Correspondence to Jens D. Agneskirchner.

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Holschen, M., Dugaro, S. & Agneskirchner, J. Arthroskopischer Korakoidtransfer. Obere Extremität 9, 106–113 (2014). https://doi.org/10.1007/s11678-014-0261-5

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  • DOI: https://doi.org/10.1007/s11678-014-0261-5

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