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Chronische Instabilität des Akromioklavikulargelenks

Aktuelles zur Ersatzplastik der korako- und akromioklavikulären Ligamente

Chronic instability of the acromioclavicular joint

Reconstruction of the coracoclavicular and acromioclavicular ligaments—current concepts

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Zusammenfassung

Unbehandelte, nicht erkannte oder unterschätzte akute Verletzungen des Schultereckgelenks sowie gescheiterte vorangegangene Therapien können zu einer chronischen Akromioklavikulargelenks-(ACG‑)Instabilität führen. Diese Instabilitäten stellen häufig eine therapeutische Herausforderung dar. Niedriggradige, isoliert vertikale ACG-Instabilitäten mit dem primären Beschwerdebild einer sekundären akromioklavikulären (AC-)Arthrose können mit einer sparsamen ACG-Resektion suffizient therapiert werden. Bei höhergradigen, unidirektionalen Instabilitäten kann ein korakoakromialer Bandtransfer (Weaver-Dunn-Verfahren) durchgeführt werden. Biomechanische und klinische Daten suggerieren hier allerdings bei einer rein korakoklavikulären (CC-)biologischen Augmentation mittels freier Sehnenplastik (Gracilis- oder Semitendinosussehne) bessere Ergebnisse. Höhergradige ACG-Instabilitäten mit kombiniert vertikaler und horizontaler Translation werden mit einer biologischen Augmentation mittels freier Sehnenplastik (Gracilis- oder Semitendinosussehne) und einem Flaschenzugimplantat versorgt. In diesem anspruchsvollen Patientengut zeigten sich im Rahmen erster arthroskopisch assistierter Techniken gute klinische und radiologische Ergebnisse mit einer akzeptablen Revisionsrate.

Abstract

Neglected, undetected or underestimated acute acromioclavicular (AC) joint injuries as well as failed previous treatment may lead to chronic AC joint instability. Treatment of these instabilities often presents a challenge. Low-grade, isolated vertical AC joint instabilities with symptomatic AC joint arthritis presenting as the major factor may be treated with careful lateral clavicle resection. High-grade, monodirectional instabilities can be treated with coracacromial ligament transfer (Weaver-Dunn). However, biomechanical and clinical data suggest that isolated coracoclavicular (CC) augmentation with a tendon transfer yields superior results. High-grade instabilities with combined vertical and horizontal translation are treated with biologic augmentation using a tendon transfer (e.g. gracilis or semitendinosus tendon) and a pulley-like implant. Clinical and radiologic results of arthroscopically assisted techniques in these challenging patients have been promising with an acceptable revision rate.

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Literatur

  1. Alexander O (1954) Radiography of the acromioclavicular articulation. Med Radiogr 30(2):34–39

    CAS  Google Scholar 

  2. Aliberti GM, Kraeutler MJ, Trojan JD, Mulcahey MK (2019) Horizontal instability of the acromioclavicular joint: a systematic review. Am J Sports Med. https://doi.org/10.1177/0363546519831013

    Article  PubMed  Google Scholar 

  3. Bircher H, Julke M, Thur C (1996) Reconstruction of chronic symptomatic acromioclavicular joint dislocation (Rockwood III–V) using the modified Weaver-Dunn method. 24 operated patients (1988–95), surgical technique, results. swiss Surg 2:46–50

    Google Scholar 

  4. Boileau P, Gastaud O, Wilson A, Trojani C, Bronsard N (2019) All-Arthroscopic reconstruction of severe chronic acromioclavicular joint dislocations. Arthroscopy 35(5):1324–1335. https://doi.org/10.1016/j.arthro.2018.11.058

    Article  PubMed  Google Scholar 

  5. Boileau P, Old J, Gastaud O, Brassart N, Roussanne Y (2010) All-arthroscopic weaver-Dunn-Chuinard procedure with double-button fixation for chronic acromioclavicular joint dislocation. Arthroscopy 26(2):149–160. https://doi.org/10.1016/j.arthro.2009.08.008

    Article  PubMed  Google Scholar 

  6. Borbas P, Churchill J, Ek ET (2019) Surgical management of chronic high-grade acromioclavicular joint dislocations: a systematic review. j Shoulder Elbow Surg. https://doi.org/10.1016/j.jse.2019.03.005

    Article  PubMed  Google Scholar 

  7. Burkhart SS, Morgan CD, Kibler WB (2003) The disabled throwing shoulder: spectrum of pathology part III: the SICK scapula, scapular dyskinesis, the kinetic chain, and rehabilitation. Arthroscopy 19(6):641–661. https://doi.org/10.1016/S0749-8063(03)00389-X

    Article  PubMed  Google Scholar 

  8. Costic RS, Labriola JE, Rodosky MW, Debski RE (2004) Biomechanical rationale for development of anatomical reconstructions of coracoclavicular ligaments after complete acromioclavicular joint dislocations. Am J Sports Med 32(8):1929–1936. https://doi.org/10.1177/0363546504264637

    Article  PubMed  Google Scholar 

  9. Fauci F, Merolla G, Paladini P, Campi F, Porcellini G (2013) Surgical treatment of chronic acromioclavicular dislocation with biologic graft vs synthetic ligament: a prospective randomized comparative study. J Orthopaed Traumatol 14:283–290

    Article  Google Scholar 

  10. Gastaud O, Raynier JL, Duparc F et al (2015) Reliability of radiographic measurements for acromioclavicular joint separations. Orthop Traumatol Surg Res 101(8):S291–S295. https://doi.org/10.1016/j.otsr.2015.09.010

    Article  CAS  PubMed  Google Scholar 

  11. Gonzalez-Lomas G, Javidan P, Lin T, Adamson G, Limpisvasti O, Lee T (2010) Intramedullary acromioclavicular ligament reconstruction strengthens isolated coracoclavicular ligament reconstruction in acromioclavicular dislocations. Am J Sport Med 38(10):2113–2122

    Article  Google Scholar 

  12. Gumina S, Carbone S, Postacchini F (2009) Scapular dyskinesis and SICK scapula syndrome in patients with chronic type III acromioclavicular dislocation. Arthroscopy 25(1):40–45. https://doi.org/10.1016/j.arthro.2008.08.019

    Article  PubMed  Google Scholar 

  13. Guy D, Wirth M, Griffin J, Rockwood C (1998) Reconstruction of chronic and complete dislocations of the acromioclavicular joint. Clin Orthop Relat Res 347:138–149

    Article  Google Scholar 

  14. Le Hanneur M, Thoreson A, Delgrande D et al (2018) Biomechanical comparison of anatomic and extra-anatomic reconstruction techniques using local grafts for chronic instability of the acromioclavicular joint. Am J Sports Med 46(8):1927–1935. https://doi.org/10.1177/0363546518770603

    Article  PubMed  Google Scholar 

  15. Hosseini H, Friedmann S, Tröger M, Lobenhoffer P, Agneskirchner JD (2009) Arthroscopic reconstruction of chronic AC joint dislocations by transposition of the coracoacromial ligament augmented by the tight rope device: a technical note. Knee Surg Sports Traumatol Arthrosc 17(1):92–97. https://doi.org/10.1007/s00167-008-0633-8

    Article  PubMed  Google Scholar 

  16. Jensen G, Katthagen JC, Alvarado L, Lill H, Voigt C (2013) Arthroscopically assisted stabilization of chronic AC-joint instabilities in GraftRopeTM technique with an additive horizontal tendon augmentation. Arch Orthop Trauma Surg 133(6):841–851. https://doi.org/10.1007/s00402-013-1745-2

    Article  PubMed  Google Scholar 

  17. Kraus N, Gerhardt C, Greiner S, Scheibel M (2010) Arthroskopische Behandlungsmöglichkeiten chronischer Schultereckgelenkinstabilitäten. Arthroskopie 23(4):293–303

    Article  Google Scholar 

  18. Kraus N, Hann C, Minkus M, Maziak N, Scheibel M (2019) Primary versus revision arthroscopically-assisted acromio- and coracoclavicular stabilization of chronic AC-joint instability. Arch Orthop Trauma Surg 139(8):1101–1109. https://doi.org/10.1007/s00402-019-03153-3

    Article  PubMed  Google Scholar 

  19. Lafosse L, Baier G, Leuzinger J (2005) Arthroscopic treatment of acute and chronic acromioclavicular joint dislocation. Arthroscopy 21(8):1017

    Article  Google Scholar 

  20. Lindenmaier H, Kuner E (1988) Treatment of chronic instability of the shoulder girdle with periosteal reinplasty. Unfallchir Versicherungsmed Berufskr 81(2):126–132

    CAS  Google Scholar 

  21. Loitz D, Klonz A (2005) Chronische instabilit??t des akromioklavikulargelenks: OP-technik. Unfallchirurg 108(12):1061–1064. https://doi.org/10.1007/s00113-005-1031-z

    Article  CAS  PubMed  Google Scholar 

  22. Luis GE, Yong CK, Singh DA, Sengupta S, Choon DSK (2007) Acromioclavicular joint dislocation: A comparative biomechanical study of the palmaris-longus tendon graft reconstruction with other augmentative methods in cadaveric models. J Orthop Surg Res 2(1):1–10. https://doi.org/10.1186/1749-799X-2-22

    Article  Google Scholar 

  23. Mazzocca AD, Arciero RA, Bicos J (2007) Evaluation and treatment of acromioclavicular joint injuries. Am J Sports Med 35(2):316–329. https://doi.org/10.1177/0363546506298022

    Article  PubMed  Google Scholar 

  24. Millett PJ, Braun S, Gobezie R, Pacheco IH (2009) Acromioclavicular joint reconstruction with coracoacromial ligament transfer using the docking technique. BMC Musculoskelet Disord 10:1–8. https://doi.org/10.1186/1471-2474-10-6

    Article  Google Scholar 

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

    Article  Google Scholar 

  26. Pavlik A, Csepai D, Hidas P (2001) Surgical treatment of chronic acromioclavicular joint dislocation by modified Weaver-Dunn procedure. Knee Surg Sport Traumatol Arthrosc 9(5):307–312

    Article  CAS  Google Scholar 

  27. Scheibel M, Ifesanya A, Pauly S, Haas NP (2008) Arthroscopically assisted coracoclavicular ligament reconstruction for chronic acromioclavicular joint instability. Arch Orthop Trauma Surg 128(11):1327–1333. https://doi.org/10.1007/s00402-007-0547-9

    Article  PubMed  Google Scholar 

  28. Shin S, Campbell S, Scott J, McGarry M, Lee T (2014) Simultaneous anatomic reconstruction of the acromioclavicular and coracoclavicular ligaments using a single tendon graft. Knee Surg Sports Traumatol Arthrosc 22(9):2216–2222

    Article  Google Scholar 

  29. Song T, Yan X, Ye T (2016) Comparison of the outcome of early and delayed surgical treatment of complete acromioclavicular joint dislocation. Knee Surg Sports Traumatol Arthrosc 24(6):1943–1950. https://doi.org/10.1007/s00167-014-3225-9

    Article  PubMed  Google Scholar 

  30. Tauber M, Eppel M, Resch H (2007) Acromioclavicular reconstruction using autogenous semitendinosus tendon graft: results of revision surgery in chronic cases. J Shoulder Elbow Surg 16(4):429–433. https://doi.org/10.1016/j.jse.2006.10.009

    Article  PubMed  Google Scholar 

  31. Tauber M, Gordon K, Koller H, Fox M, Resch H (2009) Semitendinosus tendon graft versus a modified Weaver-Dunn procedure for acromioclavicular joint reconstruction in chronic cases: a prospective comparative study. Am J Sports Med 37(1):181–190. https://doi.org/10.1177/0363546508323255

    Article  PubMed  Google Scholar 

  32. Tauber M, Koller H, Hitzl W, Resch H (2010) Dynamic radiologic evaluation of horizontal instability in acute acromioclavicular joint dislocations. Am J Sports Med 38(6):1188–1195. https://doi.org/10.1177/0363546510361951

    Article  PubMed  Google Scholar 

  33. 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):482–489. https://doi.org/10.1177/0363546515615583

    Article  PubMed  Google Scholar 

  34. Weaver JK, Dunn HK (1972) J Bone Joint Surg 54-A(6):1187–1194

    Article  Google Scholar 

  35. Weinstein DM, Mccann PD, Mcllveen SJ, Flatow EL, Bigliani LU (1995) Surgical treatment of complete acromioclavicular dislocations. Am J Sports Med 23(3):324–331. https://doi.org/10.1177/036354659502300313

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Klinik für Orthopädie und Orthopädische Chirurgie, Zentrum für Orthopädie, Unfallchirurgie und Rehabilitative Medizin, Universitätsmedizin Greifswald, Ferdinand-Sauerbruch-Straße, 17475, Greifswald, Deutschland

    Natascha Kraus-Spieckermann

  2. Schulter- und Ellenbogenchirurgie, Schulthess Klinik, Zürich, Schweiz

    Markus Scheibel

  3. Centrum für Muskuloskeletale Chirurgie, Charité – Universitätsmedizin Berlin, Berlin, Deutschland

    Markus Scheibel

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  1. Natascha Kraus-Spieckermann
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Correspondence to Natascha Kraus-Spieckermann.

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Interessenkonflikt

N. Kraus-Spieckermann und M. Scheibel geben an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden von den Autoren keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

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Kraus-Spieckermann, N., Scheibel, M. Chronische Instabilität des Akromioklavikulargelenks. Obere Extremität 15, 86–92 (2020). https://doi.org/10.1007/s11678-020-00566-0

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