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Minimalinvasive Schultereckgelenkstabilisierung mit freiem Sehnentransplantat

Minimally invasive acromioclavicular joint stabilization with a free tendon autograft

  • Leitthema
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Zusammenfassung

Chronische Akromioklavikulargelenk (ACG)-Stabilisierungen sowie Revisionen nach fehlgeschlagenen Initialstabilisierungen stellen weiterhin eine große Herausforderung für den behandelnden Orthopäden dar. In diesen Fällen ist von einer Heilung der korakoklavikulären (CC) Ligamente mit einer suffizienten ACG-Stabilität nicht auszugehen. Verschiedene Verfahren wurden zur Behandlung der chronischen Instabilitäten beschrieben, wobei sich diese in anatomische und nichtanatomische Techniken unterteilen lassen. Der Grundgedanke dieser Verfahren ist neben einer suffizienten Stabilität eine biologische Basis zur späteren Ligamentisation der CC-Ligamente zu schaffen. So entwickelte sich die anatomische, minimalinvasive Operationstechnik mittels TightRope™ (Fa. Arthrex, FL/USA) oder ähnlichen Flaschenzugsystemen in Kombination mit einem freien Sehnentransplantat in den letzten Jahren zu einer akzeptierten und sich zunehmend verbreitenden Behandlungsoption von chronischen ACG-Instabilitäten.

Abstract

Revision surgery following unsuccessful acromioclavicular (AC) joint stabilization and chronic joint instability presents a great challenge in orthopedics. In those cases, sufficient healing of the coracoclavicular (CC) ligaments cannot be expected. Different kinds of procedures are described for the operative treatment of chronic AC joint instability that can be divided into anatomic and non-anatomic techniques. The basic idea is to provide stability and a biological basis for the ligamentization process of the CC ligaments. The anatomic, minimally invasive operation techniques using TightRope™ or similar pulley systems in combination with a free tendon autograft have turned to a widely accepted and used treatment for chronic acromioclavicular (AC) joint separations.

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Literatur

  1. Breslow MJ, Jazrawi LM, Bernstein AD et al (2002) Treatment of acromioclavicular joint separation: suture or suture anchors? J Shoulder Elbow Surg 11: 225–229

    Article  PubMed  Google Scholar 

  2. Chambler AF, Bull AM, Reilly P et al (2003) Coracoacromial ligament tension in vivo. J Shoulder Elbow Surg 12:365–367

    Article  CAS  PubMed  Google Scholar 

  3. Clayton RA, Court-Brown CM (2008) The epidemiology of musculoskeletal tendinous and ligamentous injuries. Injury 39:1338–1344

    Article  PubMed  Google Scholar 

  4. Colosimo AJ, Hummer CD 3rd, Heidt RS Jr (1996) Aseptic foreign body reaction to Dacron graft material used for coracoclavicular ligament reconstruction after type III acromioclavicular dislocation. Am J Sports Med 24:561–563

    Article  CAS  PubMed  Google Scholar 

  5. Costic RS, Labriola JE, Rodosky MW et al (2004) Biomechanical rationale for development of anatomical reconstructions of coracoclavicular ligaments after complete acromioclavicular joint dislocations. Am J Sports Med 32:1929–1936

    Article  PubMed  Google Scholar 

  6. Cote MP, Wojcik KE, Gomlinski G et al (2010) Rehabilitation of acromioclavicular joint separations: operative and nonoperative considerations. Clin Sports Med 29:213–228, vii

    Article  PubMed  Google Scholar 

  7. Dearden PM, Ferran NA, Maqsood M (2010) A modified Weaver-Dunn procedure without need for internal fixation. Acta Orthop Belg 76:120–123

    PubMed  Google Scholar 

  8. DeBerardino TM, Pensak MJ, Ferreira J et al (2010) Arthroscopic stabilization of acromioclavicular joint dislocation using the AC graftrope system. J Shoulder Elbow Surg 19:47–52

    Article  PubMed  Google Scholar 

  9. Dewar FP, Barrington TW (1965) The Treatment of Chronic Acromio-Clavicular Dislocation. J Bone Joint Surg Br 47:32–35

    CAS  PubMed  Google Scholar 

  10. Dias JJ, Gregg PJ (1991) Acromioclavicular joint injuries in sport. Recommendations for treatment. Sports Med 11:125–132

    Article  CAS  PubMed  Google Scholar 

  11. 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  PubMed  Google Scholar 

  12. Ferris BD, Bhamra M, Paton DF (1989) Coracoid process transfer for acromioclavicular dislocations. A report of 20 cases. Clin Orthop Relat Res 242:184–194

    Google Scholar 

  13. 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

    Article  CAS  PubMed  Google Scholar 

  14. Greenberg JA, Mosher JF Jr, Fatti JF (1997) X-ray changes after expanded polytetrafluoroethylene (Gore-Tex) interpositional arthroplasty. J Hand Surg Am 22:658–663

    Article  CAS  PubMed  Google Scholar 

  15. Guy DK, Wirth MA, Griffin JL et al (1998) Reconstruction of chronic and complete dislocations of the acromioclavicular joint. Clin Orthop Relat Res 347:138–149

    Article  Google Scholar 

  16. Harris RI, Vu DH, Sonnabend DH et al (2001) Anatomic variance of the coracoclavicular ligaments. J Shoulder Elbow Surg 10:585–588

    Article  CAS  PubMed  Google Scholar 

  17. Harris RI, Wallace AL, Harper GD et al (2000) Structural properties of the intact and the reconstructed coracoclavicular ligament complex. Am J Sports Med 28:103–108

    Article  CAS  PubMed  Google Scholar 

  18. Herrmann S, Schmidmaier G, Greiner S (2009) Stabilisation of vertical unstable distal clavicular fractures (Neer 2b) using locking T-plates and suture anchors. Injury 40:236–239

    Article  CAS  PubMed  Google Scholar 

  19. Hosseini H, Friedmann S, Troger M et al (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 17:92–97

    Article  PubMed  Google Scholar 

  20. Jackson DW, Grood ES, Goldstein JD et al (1993) A comparison of patellar tendon autograft and allograft used for anterior cruciate ligament reconstruction in the goat model. Am J Sports Med 21:176–185

    Article  CAS  PubMed  Google Scholar 

  21. Jones HP, Lemos MJ, Schepsis AA (2001) Salvage of failed acromioclavicular joint reconstruction using autogenous semitendinosus tendon from the knee. Surgical technique and case report. Am J Sports Med 29:234–237

    Article  CAS  PubMed  Google Scholar 

  22. Kirchhoff C, Braunstein V, Buhmann S et al (2008) A salvage procedure for failed Weaver-Dunn reconstruction. Oper Orthop Traumatol 20:176–181

    Article  PubMed  Google Scholar 

  23. Kraus N, Gerhardt C, Greiner S et al (2010) Arthroskopische Behandlungsmöglichkeiten chronischer Schultereckgelenkinstabilitäten. Arthroskopie 23:293–303

    Article  Google Scholar 

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

    Article  PubMed  Google Scholar 

  25. LaPrade RF, Hilger B (2005) Coracoclavicular ligament reconstruction using a semitendinosus graft for failed acromioclavicular separation surgery. Arthroscopy 21:1277

    Article  PubMed  Google Scholar 

  26. Lee SJ, Nicholas SJ, Akizuki KH et al (2003) Reconstruction of the coracoclavicular ligaments with tendon grafts: a comparative biomechanical study. Am J Sports Med 31:648–655

    Article  PubMed  Google Scholar 

  27. Liu HH, Chou YJ, Chen CH et al (2010) Surgical treatment of acute acromioclavicular joint injuries using a modified Weaver-Dunn procedure and clavicular hook plate. Orthopedics 33:552

    Google Scholar 

  28. Mazzocca AD, Arciero RA, Bicos J (2007) Evaluation and treatment of acromioclavicular joint injuries. Am J Sports Med 35:316–329

    Article  PubMed  Google Scholar 

  29. Mazzocca AD, Santangelo SA, Johnson ST et al (2006) A biomechanical evaluation of an anatomical coracoclavicular ligament reconstruction. Am J Sports Med 34:236–246

    Article  PubMed  Google Scholar 

  30. Michlitsch MG, Adamson GJ, Pink M et al (2010) Biomechanical comparison of a modified Weaver-Dunn and a free-tissue graft reconstruction of the acromioclavicular joint complex. Am J Sports Med 38:1196–1203

    Article  PubMed  Google Scholar 

  31. Morrison DS, Lemos MJ (1995) Acromioclavicular separation. Reconstruction using synthetic loop augmentation. Am J Sports Med 23:105–110

    Article  CAS  PubMed  Google Scholar 

  32. Mouhsine E, Garofalo R, Crevoisier X et al (2003) Grade I and II acromioclavicular dislocations: results of conservative treatment. J Shoulder Elbow Surg 12:599–602

    Article  PubMed  Google Scholar 

  33. Noyes FR, Butler DL, Grood ES et al (1984) Biomechanical analysis of human ligament grafts used in knee-ligament repairs and reconstructions. J Bone Joint Surg Am 66:344–352

    Article  CAS  PubMed  Google Scholar 

  34. Phillips AM, Smart C, Groom AF (1998) Acromioclavicular dislocation. Conservative or surgical therapy. Clin Orthop Relat Res 353:10–17

    Article  Google Scholar 

  35. 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  PubMed  Google Scholar 

  36. 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  PubMed  Google Scholar 

  37. Scheibel M, Ifesanya A, Pauly S et al (2008) Arthroscopically assisted coracoclavicular ligament reconstruction for chronic acromioclavicular joint instability. Arch Orthop Trauma Surg 128:1327–1333

    Article  PubMed  Google Scholar 

  38. Tauber M, Gordon K, Koller H et al (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 37:181–190

    Article  PubMed  Google Scholar 

  39. Tienen TG, Oyen JF, Eggen PJ (2003) A modified technique of reconstruction for complete acromioclavicular dislocation: a prospective study. Am J Sports Med 31:655–659

    Article  PubMed  Google Scholar 

  40. 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  PubMed  Google Scholar 

  41. Walz L, Buchmann S, Imhoff AB (2008) Augmentation mit TightRope™ und Grazilissehne nach fehlgeschlagener ACG-Stabilisierung. Arthroskopie 21:122–129

    Article  Google Scholar 

  42. 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  PubMed  Google Scholar 

  43. Weaver JK, Dunn HK (1972) Treatment of acromioclavicular injuries, especially complete acromioclavicular separation. J Bone Joint Surg Am 54:1187–1194

    Article  CAS  PubMed  Google Scholar 

  44. Wellmann M, Lodde I, Schanz S et al (2008) Biomechanical evaluation of an augmented coracoacromial ligament transfer for acromioclavicular joint instability. Arthroscopy 24:1395–1401

    Article  PubMed  Google Scholar 

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Interessenkonflikt

Der korrespondierende Autor weist auf folgende Beziehung hin: Er war Research Fellow der Deutschsprachigen Arbeitsgemeinschaft für Arthroskopie.

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  1. Abteilung für Sportorthopädie, Klinikum rechts der Isar, TU München, München, Deutschland

    D. Hensler & A.B. Imhoff

  2. Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, University of Pittsburgh, 3471 Fifth Avenue, Suite 1011, 15213, Pittsburgh, PA, USA

    D. Hensler

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  1. D. Hensler
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  2. A.B. Imhoff
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Correspondence to D. Hensler.

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Hensler, D., Imhoff, A. Minimalinvasive Schultereckgelenkstabilisierung mit freiem Sehnentransplantat. Obere Extremität 6, 99–107 (2011). https://doi.org/10.1007/s11678-011-0111-7

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