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Arthroskopische Resektion des Akromioklavikulargelenks

Arthroscopic resection of the acromioclavicular joint

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Zusammenfassung

Operationsziel

Arthroskopische Resektion des schmerzhaft degenerativ veränderten Akromioklavikulargelenks (AC-Gelenk) unter Erhalt der ligamentären Stabilisatoren zur Schmerzlinderung und damit zur Funktionsverbesserung der Schulter.

Indikationen

Konservativ erfolglos therapierte schmerzhafte Arthrose des AC-Gelenks, Impingement durch kaudale AC-Gelenkosteophyten, Osteolyse der lateralen Klavikula.

Kontraindikationen

Allgemeine Kontraindikationen (Infekt, Tumor im Operationsgebiet, Gerinnungsstörungen), höhergradige Instabilität des AC-Gelenks (Resektion nur zusammen mit gleichzeitiger Stabilisierung).

Operationstechnik

Diagnostische glenohumerale Arthroskopie. Behandlung von Begleitläsionen (subakromiales Impingement, Rotatorenmanschette, lange Bizepssehne). Eingehen in den subakromialen Raum, Bursektomie (partiell) und Darstellen des AC-Gelenks. Abtragen kaudaler Osteophyten. Lokalisation des anterioren Portals in „Outside-in“-Technik mit Spinalnadel. Resektion von 2–3 mm des medialen Akromions und 3–4 mm der lateralen Klavikula mit Shaver/Fräse. Blutstillung.

Ergebnisse

In 9 Arbeiten wurde eine isoliert offene und in 6 Arbeiten eine rein arthroskopische Resektion des AC-Gelenks beschrieben. Gute und sehr gute klinische Ergebnisse wurden bei 79 % (54–100 %) der offenen Resektionen und bei 91 % (85–100 %) der arthroskopischen Resektionen erzielt. Dabei konnten Patienten nach einer arthroskopischen Operation schneller wieder zu ihren Alltags- und sportlichen Aktivitäten zurückkehren als nach einer offenen Operation.

Abstract

Objective

Arthroscopic resection of the painful and degenerative altered acromioclavicular (AC) joint without destabilization of the joint and therefore pain relief and improvement in function.

Indications

Conservative failed therapy of painful AC joint osteoarthritis. Impingement caused by caudal AC joint osteophytes. Lateral clavicular osteolysis.

Contraindications

General contraindications (infection, local tumor, coagulation disorders), higher grade instability of the AC joint (resection only together with stabilization).

Surgical technique

Diagnostic glenohumeral arthroscopy. Treatment of accompanying lesions (subacromial impingement, rotator cuff, long head of biceps). Subacromial arthroscopy with bursectomy (partial) and visualization of the AC joint. Resection of caudal osteophytes. Localization of the anterior portal using a spinal needle in the outside-in technique. Resection of 2–3 mm of the acromial side and the 3–4 mm of the clavicular side with shaver/acromionizer.

Results

An isolated open AC joint resection was performed in 9 studies and an arthroscopic resection in 6 studies. Good and very good results were obtained in 79 % (range 54–100 %) in open resection and 91 % (range 85–100 %) in arthroscopic resections. Patients were able to return to activities of daily life more quickly after arthroscopic resections than after open surgery.

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Einhaltung ethischer Richtlinien

Interessenkonflikt. T. Tischer, R. Lenz und P.C. Kreuz geben an, dass kein Interessenkonflikt besteht. Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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  1. Sektion Sportorthopädie und Prävention, Orthopädische Klinik und Poliklinik, Universitätsmedizin Rostock, Doberanerstr. 142, 18057, Rostock, Deutschland

    R. Lenz, P.C. Kreuz &  T. Tischer

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  1. R. Lenz
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  2. P.C. Kreuz
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  3. T. Tischer
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Correspondence to T. Tischer.

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Lenz, R., Kreuz, P. & Tischer, T. Arthroskopische Resektion des Akromioklavikulargelenks. Oper Orthop Traumatol 26, 245–253 (2014). https://doi.org/10.1007/s00064-013-0279-7

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  • DOI: https://doi.org/10.1007/s00064-013-0279-7

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