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Arthroskopisch assistierte Versorgung der akuten Instabilität des Akromioklavikulargelenks

Was haben wir in über 10 Jahren klinischer Erfahrung gelernt?

Arthroscopically assisted treatment of acute acromioclavicular joint instability

What have we learned from 10 years of experience?

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Zusammenfassung

Instabilitäten am Schultereckgelenk gehören zu den häufigsten Verletzungsfolgen am Schultergürtel. In den letzten Jahren haben sich die arthroskopisch assistierten (und auch minmalinvasiven) Doppelbuttontechniken zur operativen Stabilisierung zunehmend etabliert und finden breite Anwendung. Zwischenzeitlich liegt ein klinischer Erfahrungsschatz von mehr als 10 Jahren vor. Die vorliegenden mittelfristigen Resultate sowohl mit einem, wie auch mit zwei Implantaten sind überwiegend sehr gut mit akzeptablen Revisionsraten. Weitere Vorteile der Technik mit flexiblen kortikalen Fixationsbuttons sind das Vermeiden eines Zweiteingriffs zur Implantatentfernung sowie die Möglichkeit zur Identifikation und einzeitigen Behandlung von glenohumeralen Begleitpathologien, die in bis zu 53 % anzutreffen sind. In 12 % der höhergradigen Akromioklavikulargelenkinstabilitäten sind zusätzliche rekonstruktive Maßnahmen zur Adressierung der Begleitpathologien indiziert. Im direkten Vergleich zu den konventionellen Verfahren wie der Hakenplatte zeigen aktuelle Arbeiten teils signifikant bessere klinische Resultate. Die Operationstechnik und die Implantate wurden konsequent weiterentwickelt. Für einen optimalen Behandlungserfolg sollte neben einer korakoklavikulären Stabilisierung auch eine zusätzliche horizontale Augmentation der akromioklavikulären Ligamente durchgeführt werden.

Abstract

Instabilities of the acromioclavicular joint (ACJ) account for a majority of injuries to the shoulder girdle. Over the past years, both the arthroscopy-assisted and minimally invasive double-button techniques have become established as the techniques of choice for the surgical management of aforementioned injuries. In the meantime, data that have been collected over the past 10 years are now available. The midterm results of single and double implant procedures show good outcomes with acceptable rates of revision procedures. Advantages of the technique with flexible cortical fixation buttons are the avoidance of a secondary implant removal operation and the opportunity to identify and treat accompanying glenohumeral pathologies, which are found in up to 53% of cases. In 12% of high-grade ACJ instabilities further reconstructive measures that aim to address accompanying pathologies are indicated. When compared directly to conventional procedures, such as the hook plate, current data on the double-button technique show significantly better results. Both the surgical technique and the implants were consistently developed. For optimal treatment outcomes, both coracoclavicular stabilization and horizontal augmentation of the acromioclavicular ligaments are recommended.

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Authors and Affiliations

  1. Klinik für Orthopädie und Unfallchirurgie, BG Klinikum Hamburg im DIAKOVERE Friederikenstift, Humboldtstraße 5, 30169, Hannover, Deutschland

    Gunnar Jensen, Rony-Orijit Dey Hazra, Marek Hanhoff & Helmut Lill

  2. Orthopädische Klinik der Medizinischen Hochschule Hannover (MHH), DIAKOVERE Annastift, Hannover, Deutschland

    Alexander Ellwein

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Correspondence to Gunnar Jensen.

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Interessenkonflikt

H. Lill ist als Berater sowie Referent für die Firma Arthrex sowie als Referent für die Firma DePuy Synthes tätig. A. Ellwein ist als Referent für die Firma Arthrex tätig. G. Jensen, R.-O. Dey Hazra und M. Hanhoff geben an, dass kein Interessenkonflikt besteht.

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Jensen, G., Dey Hazra, RO., Hanhoff, M. et al. Arthroskopisch assistierte Versorgung der akuten Instabilität des Akromioklavikulargelenks. Obere Extremität 15, 77–85 (2020). https://doi.org/10.1007/s11678-020-00567-z

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