Minimalinvasive Techniken zur Therapie der Schultereckgelenksprengung

Sprengungen des Schultereckgelenks gehören zu den häufigsten Verletzungen des Schultergürtels. Neben der Symptomlinderung stehen die Gelenkstabilisierung und Wiederaufnahme körperlicher Aktivitäten im Vordergrund. Zur operativen Versorgung wurden minimalinvasive (arthroskopische bzw. arthroskopisch assistierte) Techniken entwickelt, die sich gegenüber offenen Verfahren als mindestens gleichwertig zeigen. In diesem Beitrag sollen diese minimalinvasiven Techniken detailliert beschrieben werden.

Abstract

Acromioclavicular joint instabilities are one of the most common injuries of the shoulder girdle. Diagnostic measures include the vertical and horizontal components of instability. The main goals of treatment include pain reduction, joint stabilization, and return to physical activity. For operative treatment, there are numerous techniques available. Recently, minimally-invasive techniques were developed and showed equal results as with open approach. These procedures facilitate simultaneous treatment of concomitant shoulder lesions and reduce soft tissue trauma as well as the risk of infection. This article presents an overview of such minimally-invasive techniques for both acute and chronic instabilities. Both techniques address the aspect of horizontal instability, which was found to compromise clinical results. For an acute injury, we describe the use of a low-profile button system combined with an additional acromioclavicular cerclage. In the chronic setting with a bidirectional (vertical and horizontal) instability, a free tendon graft combined with a single TightRope augmentation is recommended.

Kernaussagen

• Bei der Diagnostik der Schultereckgelenksprengung muss die horizontale Instabilität berücksichtigt werden.

• Arthroskopische Techniken erlauben die gleichzeitige Behandlung von glenohumeralen Begleitpathologien.

• Bildwandlerkontrollierte Techniken gewährleisten eine sichere Bohrkanalplatzierung und reduzieren das Risiko einer Verletzung neurovaskulärer Strukturen.

• Die zusätzliche akromiale Stabilisation mittels AC-Cerclage reduziert die horizontale Instabilität.

• Bei chronischen Instabilitäten ermöglicht ein Sehnengraft mit synthetischer Augmentation eine adäquate Stabilität.

• Arthroskopische und arthroskopisch assistierte Techniken sind den offenen Techniken mittelfristig mindestens ebenbürtig.

Schlüsselwörter

Schultereckgelenksprengung - akromioklavikular - Instabilität - arthroskopisch - Schulter

Keywords

acromioclavicular joint - shoulder instability - arthroscopic - shoulder surgery

Publication History

Article published online:
04 April 2023

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