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Knöcherne Glenoidverletzungen

Bedeutung, Diagnostik, Therapie

Bony injuries of the glenoid cavity

Importance, diagnostics and therapy

  • Leitthema
  • Published:
Arthroskopie Aims and scope

Zusammenfassung

Hintergrund

Die knöcherne Läsion des Glenoids nach vorderer Schulterluxation ist eine häufige Begleitpathologie. Eine Inzidenz von 41 % nach Erstluxation bis 90 % bei rezidivierender Luxation wurde beschrieben. Untersuchungen der Ursache unzufriedenstellender Ergebnisse nach Bankart-Operationen mit alleiniger Weichteilstabilisierung haben gezeigt, dass in den meisten Fällen eine relevante knöcherne Läsion außer Acht gelassen wurde.

Diagnostik

Das konventionelle Röntgen hat weiterhin seinen diagnostischen Stellenwert im Rahmen der Behandlung von Schulterluxationen. Gerade die Beurteilung der knöchernen Integrität des Glenoids kann jedoch selbst auf Zielaufnahmen schwierig sein. Daher ist die Durchführung einer Computertomographie (CT) auch schon nach Erstluxation empfehlenswert.

Therapie

Wird eine knöcherne Läsion des Glenoids rechtzeitig erkannt, so ist je nach Fragmentgröße dessen Refixation durch Fadenanker oder Schraubenosteosynthese indiziert, wodurch eine anatomische Rekonstruktion und damit ein stabiles Schultergelenk erreicht werden kann. Bei chronischer Defektsituation mit teilweise resorbiertem Fragment ist eine knöcherne Augmentation des Glenoids entweder durch Korakoidtransfer oder Beckenkammspan erforderlich, um eine andauernde Stabilität zu erreichen.

Schlussfolgerung

Nach Luxation des Schultergelenks muss vor weiterer Therapieplanung die Beschaffenheit des Glenoids exakt beurteilt werden. Hierzu ist ein CT auch schon nach Erstluxation empfehlenswert. So kann ggf. frühzeitig eine Osteosynthese durchgeführt und eine spätere autologe Knochentransplantation zur Rekonstruktion eines chronischen Defekts durch Korakoidtransfer oder Beckenkammspan vermieden werden.

Abstract

Background

Osseous lesions of the glenoid cavity after anterior dislocation of the shoulder joint are a common accompanying pathology. The incidence ranges from 41 % after first time dislocations to 90 % with recurrent dislocations. Investigations searching for possible reasons for unsatisfactory results of Bankart operations with soft tissue stabilization alone have shown that in most cases such osseous lesions had not been taken into account when planning the individual surgical procedures.

Diagnosis

Conventional x-ray imaging remains the main diagnostic tool for treatment of shoulder dislocations; however, assessment of the osseous integrity of the glenoid cavity can be problematic even with additional images. Therefore, a computed tomography (CT) scan of the shoulder joint is recommended even after first time dislocations.

Therapy

If an osseous lesion of the glenoid cavity is diagnosed in time, refixation either by suture anchors or screws is indicated depending on the fragment size. This allows anatomical reconstruction of the glenoid cavity and most likely results in a stable shoulder joint. With chronic defects of the glenoid cavity and partially resorbed osseous fragments, bony augmentation either by coracoid transfer or a transplant from the iliac crest is required to achieve permanent stability.

Conclusion

Exact assessment of the osseous condition of the glenoid cavity is crucial for planning further therapeutic steps. In this respect a CT scan is recommended even after first time dislocation. Thus, early refixation of such fragments can avoid the possible necessity of autologous bone augmentation either by coracoid transfer or iliac crest graft.

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Literatur

  1. Griffith JF, Antonio GE, Tong CW, Ming CK (2003) Anterior shoulder dislocation: quantification of glenoid bone loss with CT. Ajr Am J Roentgenol 180:1423–1430

    Article  PubMed  Google Scholar 

  2. Sugaya H, Moriishi J, Dohi M, Kon Y, Tsuchiya A (2003) Glenoid rim morphology in recurrent anterior glenohumeral instability. J Bone Joint Surg Am 85-a:878–884

    PubMed  Google Scholar 

  3. Bigliani LU, Newton PM, Steinmann SP, Connor PM, McLlveen SJ (1998) Glenoid rim lesions associated with recurrent anterior dislocation of the shoulder. Am J Sports Med 26:41–45

    CAS  PubMed  Google Scholar 

  4. Hintermann B, Gachter A (1995) Arthroscopic findings after shoulder dislocation. Am J Sports Med 23:545–551

    Article  CAS  PubMed  Google Scholar 

  5. Gutierrez V, Monckeberg JE, Pinedo M, Radice F (2012) Arthroscopically determined degree of injury after shoulder dislocation relates to recurrence rate. Clin Orthop Relat Res 470:961–964

    Article  PubMed Central  PubMed  Google Scholar 

  6. Hayashida K, Yoneda M, Nakagawa S, Okamura K, Fukushima S (1998) Arthroscopic Bankart suture repair for traumatic anterior shoulder instability: analysis of the causes of a recurrence. Arthroscopy 14:295–301

    Article  CAS  PubMed  Google Scholar 

  7. Burkhart SS, De Beer JF (2000) Traumatic glenohumeral bone defects and their relationship to failure of arthroscopic Bankart repairs: significance of the inverted-pear glenoid and the humeral engaging Hill-Sachs lesion. Arthroscopy 16:677–694

    Article  CAS  PubMed  Google Scholar 

  8. Itoi E, Lee SB, Berglund LJ, Berge LL, An KN (2000) The effect of a glenoid defect on anteroinferior stability of the shoulder after Bankart repair: a cadaveric study. J Bone Joint Surg Am 82:35–46

    CAS  PubMed  Google Scholar 

  9. Yamamoto N, Itoi E, Abe H, Kikuchi K, Seki N, Minagawa H et al (2009) Effect of an anterior glenoid defect on anterior shoulder stability: a cadaveric study. Am J Sports Med 37:949–954

    Article  PubMed  Google Scholar 

  10. Baudi P, Righi P, Bolognesi D, Rivetta S, Rossi-Urtoler E, Guicciardi N et al (2005) How to identify and calculate glenoid bone deficit. Chir Organi Mov 90:145–152

    CAS  PubMed  Google Scholar 

  11. Bhatia S, Saigal A, Frank RM, Bach BR Jr, Cole BJ, Romeo AA et al (2015) Glenoid diameter is an inaccurate method for percent glenoid bone loss quantification: analysis and techniques for improved accuracy. Arthroscopy 31:608–614 (e601)

    Article  PubMed  Google Scholar 

  12. Moroder P, Ernstbrunner L, Pomwenger W, Oberhauser F, Hitzl W, Tauber M et al (2015) Anterior shoulder instability is associated with an underlying deficiency of the bony glenoid concavity. Arthroscopy 31(7):1223–1231

    Article  PubMed  Google Scholar 

  13. Kim SJ, Kim SH, Park BK, Chun YM (2014) Arthroscopic stabilization for recurrent shoulder instability with moderate glenoid bone defect in patients with moderate to low functional demand. Arthroscopy 30:921–927

    Article  PubMed  Google Scholar 

  14. Shaha JS, Cook JB, Song DJ, Rowles DJ, Bottoni CR, Shaha SH et al (2015) Redefining “critical” bone loss in shoulder instability: functional outcomes worsen with “subcritical” bone loss. Am J Sports Med 43:1719–1725

    Article  PubMed  Google Scholar 

  15. Arciero RA, Parrino A, Bernhardson AS, Diaz-Doran V, Obopilwe E, Cote MP et al (2015) The effect of a combined glenoid and hill-sachs defect on glenohumeral stability: a biomechanical cadaveric study using 3-dimensional modeling of 142 patients. Am J Sports Med 43:1422–1429

    Article  PubMed  Google Scholar 

  16. Jankauskas L, Rudiger HA, Pfirrmann CW, Jost B, Gerber C (2010) Loss of the sclerotic line of the glenoid on anteroposterior radiographs of the shoulder: a diagnostic sign for an osseous defect of the anterior glenoid rim. J Shoulder Elb Surg 19:151–156

    Article  Google Scholar 

  17. Auffarth A, Mayer M, Kofler B, Hitzl W, Bogner R, Moroder P et al (2013) The interobserver reliability in diagnosing osseous lesions after first-time anterior shoulder dislocation comparing plain radiographs with computed tomography scans. J Shoulder Elb Surg 22:1507–1513

    Article  Google Scholar 

  18. Moroder P, Resch H, Schnaitmann S, Hoffelner T, Tauber M (2013) The importance of CT for the pre-operative surgical planning in recurrent anterior shoulder instability. Arch Orthop Trauma Surg 133:219–226

    Article  PubMed  Google Scholar 

  19. Huijsmans PE, Haen PS, Kidd M, Dhert WJ, van der Hulst VP, Willems WJ (2007) Quantification of a glenoid defect with three-dimensional computed tomography and magnetic resonance imaging: a cadaveric study. J Shoulder Elb Surg 16:803–809

    Article  Google Scholar 

  20. Scheibel M, Kraus N, Gerhardt C, Haas NP (2009) Anterior glenoid rim defects of the shoulder. Orthopade 38:41–48 (50-43)

    Article  CAS  PubMed  Google Scholar 

  21. Millett PJ, Braun S (2009) The “Bony Bankart Bridge” procedure: a new arthroscopic technique for reduction and internal fixation of a Bony Bankart lesion. Arthroscopy 25:102–105

    Article  PubMed  Google Scholar 

  22. Tauber M, Moursy M, Eppel M, Koller H, Resch H (2008) Arthroscopic screw fixation of large anterior glenoid fractures. Knee Surg Sports Traumatol Arthrosc 16:326–332

    Article  PubMed  Google Scholar 

  23. Lafosse L, Lejeune E, Bouchard A, Kakuda C, Gobezie R, Kochhar T (2007) The arthroscopic Latarjet procedure for the treatment of anterior shoulder instability. Arthroscopy 23:1242 (e1241-1245)

    PubMed  Google Scholar 

  24. Yamamoto N, Muraki T, An KN, Sperling JW, Cofield RH, Itoi E et al (2013) The stabilizing mechanism of the Latarjet procedure: a cadaveric study. J Bone Joint Surg Am 95:1390–1397

    Article  PubMed  Google Scholar 

  25. Neyton L, Young A, Dawidziak B, Visona E, Hager JP, Fournier Y et al (2012) Surgical treatment of anterior instability in rugby union players: clinical and radiographic results of the Latarjet-Patte procedure with minimum 5-year follow-up. J Shoulder Elb Surg 21:1721–1727

    Article  Google Scholar 

  26. Singer GC, Kirkland PM, Emery RJ (1995) Coracoid transposition for recurrent anterior instability of the shoulder. A 20-year follow-up study. J Bone Joint Surg Br 77:73–76

    CAS  PubMed  Google Scholar 

  27. Beran MC, Donaldson CT, Bishop JY (2010) Treatment of chronic glenoid defects in the setting of recurrent anterior shoulder instability: a systematic review. J Shoulder Elb Surg 19:769–780

    Article  Google Scholar 

  28. Auffarth A, Schauer J, Matis N, Kofler B, Hitzl W, Resch H (2008) The J-bone graft for anatomical glenoid reconstruction in recurrent posttraumatic anterior shoulder dislocation. Am J Sports Med 36:638–647

    Article  PubMed  Google Scholar 

  29. Kraus N, Amphansap T, Gerhardt C, Scheibel M (2014) Arthroscopic anatomic glenoid reconstruction using an autologous iliac crest bone grafting technique. J Shoulder Elb Surg 23:1700–1708

    Article  Google Scholar 

  30. Plachel F, Heuberer P, Schanda J, Pauzenberger L, Kriegleder B, Anderl W (2015) Arthroskopische J-Span-Implantation bei knöchernem Glenoiddefekt. Obere Extrem. doi: 10.1007/s11678-015-0321-5. (Epub ahead of print)

  31. Moroder P, Hirzinger C, Lederer S, Matis N, Hitzl W, Tauber M et al (2012) Restoration of anterior glenoid bone defects in posttraumatic recurrent anterior shoulder instability using the J-bone graft shows anatomic graft remodeling. Am J Sports Med 40:1544–1550

    Article  PubMed  Google Scholar 

  32. Moroder P, Blocher M, Auffarth A, Hoffelner T, Hitzl W, Tauber M et al (2014) Clinical and computed tomography-radiologic outcome after bony glenoid augmentation in recurrent anterior shoulder instability without significant glenoid bone loss. J Shoulder Elb Surg 23:420–426

    Article  Google Scholar 

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Authors and Affiliations

  1. Univ. Klinik für Unfallchirurgie und Sporttraumatologie, Paracelsus Medizinische Privatuniversität (PMU), Müllner Hauptstraße 48, 5020, Salzburg, Österreich

    A. Auffarth, F. Plachel & P. Moroder

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  1. A. Auffarth
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Correspondence to A. Auffarth.

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Interessenkonflikt

A. Auffarth, F. Plachel und P. Moroder geben an, dass kein Interessenkonflikt besteht.

Im Rahmen dieses Review wurden weder Patienten untersucht, noch behandelt. Alle berichteten Daten des eigenen Arbeitskreises stammen aus Studien mit positivem Ethikvotum.

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Redaktion

M. Flury, Zürich

P. Heuberer, Wien

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Auffarth, A., Plachel, F. & Moroder, P. Knöcherne Glenoidverletzungen. Arthroskopie 28, 267–273 (2015). https://doi.org/10.1007/s00142-015-0036-z

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  • DOI: https://doi.org/10.1007/s00142-015-0036-z

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