Chronische Instabilität bei knöchernem Defekt der Schulter

Zusammenfassung

Im Zuge der voranschreitenden Entwicklung im Bereich der operativen Versorgung chronischer Schulterinstabilitäten mit knöchernen Glenoiddefekten wurden im Bereich der knöchernen Augmentationsverfahren in den letzten Jahren verschiedene arthroskopische anatomische und extraanatomische Verfahren beschrieben. Erste vielversprechende klinische und radiologische Ergebnisse nach arthroskopischem Korakoidtransfer und arthroskopischer Beckenkammspanplastik liegen vor. Auf Basis einer pathomorphologischen Klassifikation sollte die Indikationsstellung zu einer knöchernen Augmentation streng gestellt und auch knöcherne humerale, sowie weichteilige Begleitverletzungen in der Wahl der Therapie Berücksichtigung finden. Eine Überlegenheit gegenüber offenen Techniken müssen langfristige Resultate noch zeigen.

Abstract

In the course of an advancing development in the treatment of chronic shoulder instability with accompanying bony defects, several anatomic and extraanatomic arthroscopic techniques have recently been presented. Descriptions and first clinical and radiological results of an arthroscopic coracoid transfer, as well as J-shaped and tricortical iliac crest bone grafts have been published. On the basis of a pathomorphological classification of glenoid defects, the indication for bony augmentation should be evaluated carefully and bony humeral as well as accompanying ligamentous lesions should be taken into account when choosing treatment alternatives. Long-term results are needed to show any advantages in comparison with open techniques.

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