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Arthroskopisch assistierte Stabilisierung akuter Schultereckgelenkverletzungen in Doppel-TightRope™-Technik

Einjahresergebnisse

Arthroscopically assisted stabilization of acute injury to the acromioclavicular joint with the double TightRope™ technique

One-year results

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Zusammenfassung

Hintergrund

Ziel dieser Studie war, die Evaluation der klinischen und radiologischen Ergebnisse von 37 Patienten (Durchschnittsalter 37,9 Jahre; weiblich 4, männlich 33 Patienten) mit akuten AC-Gelenksprengung Typ V nach Rockwood nach arthroskopisch assistierter und bildwandlerkontrollierter AC-Gelenkstabilisierung in Doppel-TightRope™-Technik.

Material und Methode

Nach 12 Monaten konnten 30 Patienten [Durchschnittsalter 38,8 (18,6–65,8)] Jahre anhand des „Subjective Shoulder Value“ (SSV), Constant-Scores (CS) und Taft-Score (TF) sowie radiologische mit Panorama- und Alexander-Stressaufnahmen nachuntersucht werden.

Ergebnisse

Im SSV wurden durchschnittlich 91,4±9,8% im CS 87,8±5,2 und im TF 10,1±2,1 Punkte erreicht. Präoperativ betrug der durchschnittliche korakoklavikuläre Abstand (CCA) 22,1±5,6 mm auf der betroffenen Seite und konnte 3 Wochen postoperativ signifikant auf einen CCA von 8,6±2,8 mm reduziert werden (p<0,05). Ein Jahr postoperativ zeigte sich ein mittlerer CCA von 12,9±2,4 mm. Die Differenz des CCA zur Gegenseite betrug initial 13,7±4,8 mm, postoperativ 0,3±3,0 mm und nach 12 Monaten 3,6±3,5 mm. Eine horizontale Instabilität wurde in 53,3% der Patienten beobachtet. Hier bestand eine Korrelation mit dem schlechteren funktionellen Ergebnis. Lediglich ein Patient wies nach 12 Monaten einen diskreten Druckschmerz im Bereich des AC-Gelenks auf.

Schlussfolgerung

Nach arthroskopisch assistierter AC-Gelenkstabilisierung in Doppel-TightRope™-Technik können trotz nachgewiesener partieller Rezidivinstabilität gute bis sehr gute klinische Resultate ein Jahr postoperativ erwartet werden.

Abstract

Background

The aim of this study was to evaluate the clinical and radiological results of 37 consecutive patients (Ø age 37.9; 4♀, 33♂) following arthroscopically assisted and image intensifier-controlled AC joint reconstruction using the double TightRope™ technique for acute AC joint separations grade V according to Rockwood.

Material and methods

After 12 months 30 patients with a mean age of 38.8 years (range 18.6–65.8 years) could be included. The postoperative assessment included the Subjective Shoulder Value (SSV), Constant Score (CS), and Taft Score (TF) as well as radiological evaluation using bilateral stress views and bilateral Alexander views for determining vertical and horizontal AC joint instability.

Results

The clinical scores reached 91.4±9.8% for SSV, 87.8±5.2 for CS, and 10.1±2.1 points for TF. The initial coracoclavicular distance (CCD) was 22.1±5.6 mm and could be reduced to 8.6±2.8 mm postoperatively (p<0.05). The CCD increased at final follow-up to 12.8±2.4 mm. The difference of the CCD compared to the contralateral side was initially 13.7±4.8 mm; postoperatively it was 0.3±3.0 mm with an increase at final follow-up to 3.6±3.5 mm. A posterior instability on the Alexander view occurred in 53.3% of patients. A correlation between inferior clinical results and horizontal instability could be detected. Only one patient was slightly tender to palpation at the AC joint.

Conclusion

Following arthroscopic AC joint stabilization using the double TightRope™ technique, despite partial recurrent instability, favorable clinical results can be expected.

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Literatur

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

    CAS  Google Scholar 

  2. Bathis H, Tingart M, Bouillon B, Tiling T (2001) The status of therapy of acromioclavicular joint injury. Results of a survey of trauma surgery clinics in Germany. Unfallchirurg 104:955–960

    Article  CAS  Google Scholar 

  3. Chhabra A, Cha PS, Rihn JA et al (2005) Surgical management of knee dislocations. Surgical technique. J Bone Joint Surg Am 87(Suppl 1):1–21

    Google Scholar 

  4. Constant CR, Murley AH (1987) A clinical method of functional assessment of the shoulder. Clin Orthop Relat Res 214:160–164

    Google Scholar 

  5. Dimakopoulos P, Panagopoulos A, Syggelos SA et al (2006) Double-loop suture repair for acute acromioclavicular joint disruption. Am J Sports Med 34:1112–1119

    Article  Google Scholar 

  6. Elser F, Chernchujit B, Ansah P, Imhoff AB (2005) A new minimally invasive arthroscopic technique for reconstruction of the acromioclavicular joint. Unfallchirurg 108:645–649

    Article  CAS  Google Scholar 

  7. Fukuda K, Craig EV, An KN et al (1986) Biomechanical study of the ligamentous system of the acromioclavicular joint. J Bone Joint Surg Am 68:434–440

    CAS  Google Scholar 

  8. Gilbart MK, Gerber C (2007) Comparison of the subjective shoulder value and the Constant score. J Shoulder Elbow Surg 16:717–721

    Article  Google Scholar 

  9. Greiner S, Braunsdorf J, Perka C et al (2009) Mid to long-term results of open acromioclavicular-joint reconstruction using polydioxansulfate cerclage augmentation. Arch Orthop Trauma Surg 129:735–740

    Article  CAS  Google Scholar 

  10. Gstettner C, Tauber M, Hitzl W, Resch H (2008) Rockwood type III acromioclavicular dislocation: surgical versus conservative treatment. J Shoulder Elbow Surg 17:220–225

    Article  CAS  Google Scholar 

  11. Habernek H, Weinstabl R, Schmid L, Fialka C (1993) A crook plate for treatment of acromioclavicular joint separation: indication, technique, and results after one year. J Trauma 35:893–901

    Article  CAS  Google Scholar 

  12. Headey J, Brooks JH, Kemp SP (2007) The epidemiology of shoulder injuries in English professional rugby union. Am J Sports Med 35:1537–1543

    Article  Google Scholar 

  13. Horn JS (1954) The traumatic anatomy and treatment of acute acromio-clavicular dislocation. J Bone Joint Surg Br 36:194–201

    Google Scholar 

  14. Kippe MA, Demetropoulos CK, Baker KC et al (2009) Failure of coracoclavicular artificial graft reconstructions from repetitive rotation. Arthroscopy 25:975–982

    Article  Google Scholar 

  15. Klimkiewicz JJ, Williams GR, Sher JS et al (1999) The acromioclavicular capsule as a restraint to posterior translation of the clavicle: a biomechanical analysis. J Shoulder Elbow Surg 8:119–124

    Article  CAS  Google Scholar 

  16. Lizaur A, Marco L, Cebrian R (1994) Acute dislocation of the acromioclavicular joint. Traumatic anatomy and the importance of deltoid and trapezius. J Bone Joint Surg Br 76:602–606

    CAS  Google Scholar 

  17. Pauly S, Gerhardt C, Haas NP, Scheibel M (2009) Prevalence of concomitant intraarticular lesions in patients treated operatively for high-grade acromioclavicular joint separations. Knee Surg Sports Traumatol Arthrosc 17:513–517

    Article  Google Scholar 

  18. Rios CG, Arciero RA, Mazzocca AD (2007) Anatomy of the clavicle and coracoid process for reconstruction of the coracoclavicular ligaments. Am J Sports Med 35:811–817

    Article  Google Scholar 

  19. Rockwood C (1984) Fracture in adults. In: RCJGD (ed) Injuries in the acromioclavicular joint: Subluxations and dislocations about the shoulder. Lippincott, Philadelphia, pp 860–910

  20. Rolla PR, Surace MF, Murena L (2004) Arthroscopic treatment of acute acromioclavicular joint dislocation. Arthroscopy 20:662–668

    Article  Google Scholar 

  21. Salem KH, Schmelz A (2009) Treatment of Tossy III acromioclavicular joint injuries using hook plates and ligament suture. J Orthop Trauma 23:565–569

    Article  Google Scholar 

  22. Salzmann GM, Walz L, Buchmann S et al (2010) Arthroscopically assisted 2-bundle anatomical reduction of acute acromioclavicular joint separations. Am J Sports Med 38:1179–1187

    Article  Google Scholar 

  23. Salzmann GM, Walz L, Schoettle PB, Imhoff AB (2008) Arthroscopic anatomical reconstruction of the acromioclavicular joint. Acta Orthop Belg 74:397–400

    Google Scholar 

  24. Sim E, Schwarz N, Hocker K, Berzlanovich A (1995) Repair of complete acromioclavicular separations using the acromioclavicular-hook plate. Clin Orthop Relat Res 314:134–142

    Google Scholar 

  25. Sperling JW, Smith AM, Cofield RH, Barnes S (2007) Patient perceptions of open and arthroscopic shoulder surgery. Arthroscopy 23:361–366

    Article  Google Scholar 

  26. Sundaram N, Patel DV, Porter DS (1992) Stabilization of acute acromioclavicular dislocation by a modified Bosworth technique: a long-term follow-up study. Injury 23:189–193

    Article  CAS  Google Scholar 

  27. Taft TN, Wilson FC, Oglesby JW (1987) Dislocation of the acromioclavicular joint. An end-result study. J Bone Joint Surg Am 69:1045-1051

    CAS  Google Scholar 

  28. Tischer T, Salzmann GM, El-Azab H et al (2009) Incidence of associated injuries with acute acromioclavicular joint dislocations types III through V. Am J Sports Med 37:136–139

    Article  Google Scholar 

  29. Waldrop JI, Norwood LA, Alvarez RG (1981) Lateral roentgenographic projections of the acromioclavicular joint. Am J Sports Med 9:337–341

    Article  CAS  Google Scholar 

  30. Walsh WM, Peterson DA, Shelton G, Neumann RD (1985) Shoulder strength following acromioclavicular injury. Am J Sports Med 13:153–158

    Article  CAS  Google Scholar 

  31. Walz L, Salzmann GM, Fabbro T et al (2008) The anatomic reconstruction of acromioclavicular joint dislocations using 2 TightRope devices: a biomechanical study. Am J Sports Med 36:2398–2406

    Article  Google Scholar 

  32. Weinstein DM, McCann PD, McIlveen SJ et al (1995) Surgical treatment of complete acromioclavicular dislocations. Am J Sports Med 23:324–331

    Article  CAS  Google Scholar 

  33. Wolf EM, Pennington WT (2001) Arthroscopic reconstruction for acromioclavicular joint dislocation. Arthroscopy 17:558–563

    Article  CAS  Google Scholar 

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Authors and Affiliations

  1. Centrum für Muskuloskeletale Chirurgie (CMSC), Charité Campus Virchow-Klinikum, Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Deutschland

    C. Gerhardt, N. Kraus, S. Pauly &  M. Scheibel

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  1. C. Gerhardt
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  2. N. Kraus
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  3. S. Pauly
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  4. M. Scheibel
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Correspondence to M. Scheibel.

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Gerhardt, C., Kraus, N., Pauly, S. et al. Arthroskopisch assistierte Stabilisierung akuter Schultereckgelenkverletzungen in Doppel-TightRope™-Technik. Unfallchirurg 116, 125–130 (2013). https://doi.org/10.1007/s00113-011-2065-z

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