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.

Schlüsselwörter

Schultereckgelenksprengung - akromioklavikular - Instabilität - arthroskopisch - Schulter

Keywords

acromioclavicular joint - shoulder instability - arthroscopic - shoulder surgery

• Literatur

• 1 Nordqvist A, Petersson CJ. Incidence and causes of shoulder girdle injuries in an urban population. J Shoulder Elbow Surg 1995; 4: 107-112
• 2 Debski RE, Parsons IV IM, Woo SLY. et al. Effect of capsular injury on acromioclavicular joint mechanics. J Bone Jt Surg 2001; 83: 1344-1351
• 3 Fukuda K, Craig EV, An KN. et al. Biomechanical study of the ligamentous system of the acromioclavicular joint. J Bone Jt Surg 1986; 68: 434-440
• 4 Klimkiewicz JJ, Williams GR, Sher JS. et al. The acromioclavicular capsule as a restraint to posterior translation of the clavicle: a biomechanical analysis. J Shoulder Elbow Surg 1999; 8: 119-124
• 5 Salzmann GM, Walz L, Buchmann S. et al. Arthroscopically assisted 2-bundle anatomical reduction of acute acromioclavicular joint separations. Am J Sports Med 2010; 38: 1179-1187
• 6 Gumina S, Carbone S, Arceri V. et al. The relationship between chronic type III acromioclavicular joint dislocation and cervical spine pain. BMC Musculoskelet Disord 2009; 10: 1-7
• 7 Rockwood jr CA. Fractures and Dislocations of the Shoulder. In: Rockwood jr CA, Green DP. Fractures in Adults. Philadelphia: Lippincott; 1984: 860-910
• 8 Kraus N, Hann C, Gerhardt C. et al. Dynamic instability of the acromioclavicular joint: a new classification for acute AC joint separation. Obere Extrem 2018; 13: 279-285
• 9 Alexander OM. Radiography of the acromioclavicular articulation. Med Radiogr 1954; 30: 34-39
• 10 Tauber M, Koller H, Hitzl W. et al. Dynamic radiologic evaluation of horizontal instability in acute acromioclavicular joint dislocations. Am J Sports Med 2010; 38: 1188-1195
• 11 Minkus M, Hann C, Scheibel M. et al. Quantification of dynamic posterior translation in modified bilateral Alexander views and correlation with clinical and radiological parameters in patients with acute acromioclavicular joint instability. Arch Orthop Trauma Surg 2017; 137: 845-852
• 12 Beitzel K, Mazzocca AD, Bak K. et al. ISAKOS upper extremity committee consensus statement on the need for diversification of the Rockwood classification for acromioclavicular joint injuries. Arthroscopy 2014; 30: 271-278
• 13 Zumstein MA, Schiessl P, Ambuehl B. et al. New quantitative radiographic parameters for vertical and horizontal instability in acromioclavicular joint dislocations. Knee Surg Sports Traumatol Arthrosc 2018; 26: 125-135
• 14 Karargyris O, Murphy RJ, Arenas A. et al. Improved identification of unstable acromioclavicular joint injuries in a clinical population using the acromial center do dorsal clavicle radiographic measurement. J Shoulder Elbow Surg 2020; 29: 1599-1605
• 15 Murphy RJ, Moor BK, Lesniewski PJ. et al. Evaluation of the circles measurement and the ABC classification of of acromioclavicular injuries. Am J Sports Med 2021; 49: 1619-1625
• 16 Venjakob AJ, Salzmann GM, Gabel F. et al. Arthroscopically assisted 2-bundle anatomic reduction of acute acromioclavicular joint separations: 58 month findings. Am J Sports Med 2013; 41: 615-621
• 17 Boileau P, Gastaud O, Wilson A. et al. All-arthroscopic reconstruction of severe chronic acromioclavicular joint dislocations. Arthroscopy 2019; 35: 1324-1335
• 18 Allemann F, Halvachizadeh S, Waldburger M. et al. Different treatment strategies for acromioclavicular dislocation injuries: a nationwide survey on minimally invasive and arthroscopic concepts. Eur J Med Res 2019; 24: 18
• 19 Balke M, Schneider M, Akoto R. et al. Acute acromioclavicular joint injuries: changes in diagnosis and therapy over the last 10 years. Unfallchirurg 2014; 118: 851-857
• 20 Jensen G, Katthagen J, Alvarado L. et al. Has the arthroscopically assisted reduction of acute AC joint separations with the double tight-rope technique advantage over the clavicular hook plate fixation?. Knee Surg Sport Traumatol Arthrosc 2012; 22: 422-430
• 21 Lafosse L, Baier G, Leuzinger J. Arthroscopic treatment of acute and chronic acromioclavicular joint dislocation. Arthroscopy 2005; 21: 1017
• 22 Martetschläger F, Kraus N, Scheibel M. et al. The diagnosis and treatment of acute dislocation of the acromioclavicular joint. Dtsch Arztebl Int 2019; 116: 89-95
• 23 Stein T, Müller D, Blank M. et al. Stabilization of acute high-grade acromioclavicular joint separation: a prospective assessment of the clavicular hook plate versus the double Double-Button Suture procedure. Am J Sports Med 2018; 46: 2725-2734
• 24 Wolf EM, Pennington WT. Arthroscopic reconstruction for acromioclavicular joint dislocation. Arthroscopy 2001; 17: 558-563
• 25 Elser F, Chernchujit B, Ansah P. et al. A new minimally invasive arthroscopic technique for reconstruction of the acromioclavicular joint. Unfallchirurg 2005; 108: 645-649
• 26 Hann C, Kraus N, Minkus M. et al. Combined arthroscopically assisted coraco- and acromioclavicular stabilization of acute high-grade acromioclavicular joint separations. Knee Surg Sports Traumatol Arthrosc 2018; 26: 212-220
• 27 Minkus M, Maziak N, Moroder P. et al. Arthroscopic low-profile reconstruction for acute acromioclavicular instability. Obere Extrem 2019; 14: 60-65
• 28 Scheibel M, Dröschel S, Gerhardt C. et al. Arthroscopically assisted stabilization of acute high-grade acromioclavicular joint separations. Am J Sports Med 2011; 39: 1507-1516
• 29 Saier T, Plath JE, Beitzel K. et al. Return-to-activity after anatomical reconstruction of acute high-grade acromioclavicular separation. BMC Musculoskelet Disord 2016; 17: 145
• 30 Horst K, Garving C, Thometzki T. et al. Comparative study on the treatment of Rockwood type III acute acromioclavicular dislocation: clinical results from the TightRope® technique vs. K-wire fixation. Orthop Traumatol Surg Res 2017; 103: 171-176
• 31 Gu F, Tan L, Wang T. et al. Comparison of single versus double TightRope system in the treatment of acute acromioclavicular joint dislocation. J Shoulder Elbow 2021; 30: 1915-1923
• 32 Holschen M, Focke J, Witt KA. et al. Arthroscopically-assisted treatment of acute and chronic dislocations of the acromioclavicular joint: a prospective clinical trial. Orthopade 2021; 50: 214-223
• 33 Chaudhary D, Jain V, Joshi D. et al. Arthroscopic fixation for acute acromioclavicular joint disruption using the TightRope device. J Orthop Surug (Hong Kong) 2015; 23: 309-314
• 34 Flinkkilä TE, Ihanainen E. Results of arthroscopy-assisted TightRope repair of acromioclavicular dislocations. Shoulder Elbow 2014; 6: 18-22
• 35 Olivos-Meza A, Almazán-Diaz A, Calvo JA. et al. Radiographic displacement of acute acromioclavicular joint dislocations fixed with AC TightRope. JSES Int 2020; 4: 49-54
• 36 Nie S, Lan M. Comparison of clinical efficacy between arthroscopically assisted Tight-Rope technique and clavicular hook plate fixation in treating acute high-grade acromioclavicular joint separations. J Orthop (Hong Kong) 2021; 29
• 37 Kraus N, Haas NP, Scheibel M. et al. Arthroscopically assisted stabilization of acute high-grade acromioclavicular joint separations in a coracoclavicular Double-TightRope technique: v-shaped versus parallel drill hole orientation. Arch Orthop Trauma Surg 2013; 133: 1431-1440
• 38 Maziak N, Audige L, Hann C. et al. Factors predicting the outcome after arthroscopically assisted stabilization of acute high-grade acromioclavicular joint dislocations. Am J Sports Med 2019; 47: 2670-2677
• 39 Hosseini H, Friedmann S, Tröger M. et al. Arthroscopic reconstruction of chronic AC joint dislocations by transposition of the coracoacromial ligament augmented by the Tight Rope device: a technical note. Knee Surgery Sport Traumatol Arthrosc 2009; 17: 92-97
• 40 Dittrich M, Wirth B, Freislederer F. et al. Arthroscopic-assisted stabilization of bidirectional chronic AC-joint instability using a low-profile implant and a free tendon graft – a technical note. Obere Extrem 2020; 15: 118-121
• 41 Tauber M, Gordon K, Koller H. et al. Semitendinosus tendon graft versus a modified Weaver-Dunn procedure for acromioclavicular joint reconstruction in chronic cases: a prospective comparative study. Am J Sports Med 2009; 37: 181-190
• 42 Saccomanno MF, Fodale M, Capasso L. et al. Reconstruction of the coracoclavicular and acromioclavicular ligaments with semitendinosus tendon graft: a pilot study. Joints 2014; 1: 171-179
• 43 Tauber M, Valler D, Lichtenberg S. et al. Arthroscopic stabilization of chronic acromioclavicular joint dislocations: triple- versus single-bundle reconstruction. Am J Sports Med 2016; 44: 482-489
• 44 Saccomanno MF, Marchi G, Mocini F. et al. Anatomic reconstruction of the coracoclavicular and acromioclavicular ligaments with semitendinosus tendon graft for the treatment of chronic acromioclavicular joint dislocation provides good clinical and radiological results. Knee Surg Sports Traumatol Arthrosc 2021; 29: 2356-2363
• 45 Kraus N, Hann C, Minkus M. et al. Primary versus revision arthroscopically-assisted acromio- and coracoclavicular stabilization of chronic AC-joint instability. Arch Orthop Trauma Surg 2019; 139: 1101-1109
• 46 Muench LN, Kia C, Jerliu A. et al. Functional and radiographic outcomes after anatomic coracoclavicular ligament reconstruction for type III/V acromioclavicular joint injuries. Orthop J Sports Med 2019; 7
• 47 Cerciello S, Berthold DP, Uyeki C. et al. Anatomic coracoclavicular ligament reconstruction (ACCR) using free tendon allograft is effective for chronic acromioclavicular joint injuries at mid-term follow-up. Knee Surg Sports Traumatol Arthrosc 2021; 29: 2096-2102
• 48 Muench LN, Berthold DP, Uyeki C. et al. Conversion to anatomic coracoclavicular ligament reconstruction (ACCR) shows similar clinical outcomes compared to successful non-operative treatment in chronic primary type III to V acromioclavicular joint injuries. Knee Surg Sports Traumatol Arthrosc 2021; 29: 2264-2271
• 49 Al-Ahaideb A. Surgical treatment of chronic acromioclavicular joint dislocation using the Weaver-Dunn procedure augmented by the TightRope® system. Eur J Orthop Surg Traumatol 2014; 24: 741-745