Instabilitäten und Arthrose des Sternoklavikulargelenks

Zusammenfassung

Die Verletzung des Sternoklavikulargelenks (SCG) ist mit 3% der Schulterverletzungen und < 1% der Instabilitäten eine sehr seltene Verletzung. Folglich wird sowohl die Versorgung akuter Instabilitäten wie auch ihrer Folgezustände (chronische Instabilitäten/SCG-Arthrose) kontrovers diskutiert. Erfolgte bisher die Behandlung zumeist konservativ, so ist in den letzten Jahren eine Tendenz zur operativen Therapie zu erkennen.

Durch erhebliche Gewalteinwirkung, wie sie bei Verkehrsunfällen oder Kontaktsportarten zu finden ist, kann es zur Zerreißung des an sich äußerst stabilen Bandapparates zwischen medialer Klavikula und Sternum kommen. Während die anteriore Luxation in den meisten Fällen leichter zu reponieren ist, verbleibt in bis zu 50% der Fälle eine Instabilität. Die posteriore Instabilität bedarf in den meisten Fällen – insbesondere auch aufgrund der anatomischen Nähe zu wichtigen kardiopulmonalen Strukturen – einer raschen Reposition. Sofern dies gelingt, ist die Rate persistierender Instabilitäten gering. Für die chronischen Instabilitäten hat sich in den letzten Jahren die Rekonstruktion/Augmentation des Bandapparates mit Sehnengrafts in der „Figure-of-8-Konfiguration“ als Standardtechnik erwiesen.

Für die Arthrose des SCG kommen OP-Techniken wie die Resektion des medialen Klavikulaendes dann in Betracht, wenn die konservative Therapie als gescheitert anzusehen ist.

Schlüsselwörter

Sternoklavikulargelenk - Instabilität - Arthrose

Publication History

Received: 02 April 2023

Accepted after revision: 09 June 2023

Article published online:
30 August 2023

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