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Biomechanik aktueller Rekonstruktionstechniken bei Schultereckgelenksprengungen

Biomechanical characteristics of current stabilization techniques for acromioclavicular joint separation

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Zusammenfassung

Aktuelle Techniken der Akromioklavikulargelenk (AC)-Stabilisierung adressieren primär oder isoliert einen Ersatz der korakoklavikulären (CC) Bänder. Inwiefern dieses Vorgehen jedoch geeignet ist, neben der vertikalen Primärstabilität auch die Kinematik und Stabilität des Gelenkes in der horizontalen Ebene wiederherzustellen, ist fraglich. Die vorliegende Arbeit zeigt durch eine Übersicht biomechanischer In-vitro-Studien Stärken und Schwächen aktuell propagierter Techniken auf. So konnte biomechanisch nachgewiesen werden, dass weder isolierte korakoklavikuläre (CC) noch isolierte akromioklavikuläre (AC) Rekonstruktionen in der Lage sind, sowohl die Vertikal- als auch die Horizontalstabilität des AC-Gelenkes wiederherzustellen. Dies ist unabhängig von der Verwendung neuer Implantate, Fixationstechniken („flip-button fixation“) und der Integration von Sehnentransplantaten. Analog zu den ligamentären Stabilisatoren des intakten Gelenkes stabilisieren CC-Rekonstruktionen primär in vertikaler und AC-Rekonstruktionen primär in horizontaler Richtung. Als klinische Konsequenz ist daher neben einer detaillierten, zweidimensionalen Diagnostik der AC-Gelenkverletzungen eine an das Instabilitätsmuster angepasste operative Therapie zu fordern. Diese sollte eine bedarfsgerechte Kombination von CC- und AC-Stabilisierung beinhalten.

Abstract

Current techniques for acromioclavicular (AC) joint repair primarily focus on the reconstruction of the coracoclavicular (CC) ligaments. However, it is unclear whether this approach is sufficient to restore vertical as well as horizontal AC joint stability and kinematics. Therefore, this review summarizes the biomechanical characteristics of current procedures as they have been revealed by in vitro investigations. As a basic result, neither selective repairs of the CC ligaments nor selective repairs of the AC ligaments could be shown to restore both vertical and horizontal joint stability. Similar to the intact ligaments, CC repair primarily provides vertical joint stability, while AC repair is able to restore horizontal stability. Thereby, the lack of horizontal stability of the CC repairs could not be compensated using tendon grafts, double-bundle techniques, and flip-button fixation. In conclusion, a biomechanical effective treatment of AC joint separation should analyze the individual instability pattern in the first step. In the second step, an adequate surgical treatment considering CC and AC stabilization should be performed meeting the individual demands.

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Wellmann, M., Smith, T., Windhagen, H. et al. Biomechanik aktueller Rekonstruktionstechniken bei Schultereckgelenksprengungen. Obere Extremität 6, 85–89 (2011). https://doi.org/10.1007/s11678-011-0110-8

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  • DOI: https://doi.org/10.1007/s11678-011-0110-8

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