Arthroscopically Assisted Stabilization of Acute High-Grade                Acromioclavicular Joint Separations

Scheibel, Markus; Dröschel, Silvia; Gerhardt, Christian; Kraus, Natascha

doi:10.1177/0363546511399379

Cited by 362 publications

(402 citation statements)

References 15 publications

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“…8,10,11 For most techniques, nonbiologic suture button systems are used for allowing a proper healing process of the graft components. 10,14,20 In a recent study, Scheibel et al 21 described persistent horizontal instability in 41% cases after isolated CC double ligament stabilization. Saier et al 22 could show biomechanically that only combined AC and CC reconstruction can adequately restore physiological horizontal AC joint stability.…”

Section: Discussionmentioning

confidence: 98%

Arthroscopically Assisted Acromioclavicular and Coracoclavicular Ligament Reconstruction for Chronic Acromioclavicular Joint Instability

Martetschläger

Tauber

Habermeyer³

et al. 2016

Arthroscopy Techniques

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Acromioclavicular (AC) joint injuries are common injuries, especially in the young and active, male population. AC joint injuries account for 12% of all injuries of the shoulder girdle in the overall population. Although conservative treatment is recommended for Rockwood type I and type II injuries, there is controversial debate about optimal treatment for type III injuries. High-grade injuries are typically treated operatively to avoid painful sequelae. A vast number of different surgical methods have been described over the past few decades. Recent advances in arthroscopic surgery have enabled the shoulder surgeon to treat acute and chronic AC lesions arthroscopically assisted. Clinical studies have already shown good and reliable results. Although surgeons agree that a biological augmentation is required to minimize the risk of recurrent instability in chronic cases, a gold standard still needs to be defined. We present an arthroscopically assisted biological augmentation technique to reconstruct the AC and coracoclavicular ligaments, protected by a button-suture tape construct for chronic AC joint instability. The presented arthroscopic biological augmentation technique uses less and/or smaller drill holes in the clavicle and coracoid than previously described, thus reducing weakening of the bony structures. At the same time it enhances both horizontal and vertical stability.

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Section: Discussionmentioning

confidence: 98%

Arthroscopically Assisted Acromioclavicular and Coracoclavicular Ligament Reconstruction for Chronic Acromioclavicular Joint Instability

Martetschläger

Tauber

Habermeyer³

et al. 2016

Arthroscopy Techniques

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“…Ossification around the CC ligaments is a phenomenon that has already been described in several articles, 15,19) which still to date, has not been fully elucidated. We were unable to correlate the degree of ossification or the existence of ossification with any of the clinical parameters.…”

Section: Discussionmentioning

confidence: 99%

“…These authors emphasized that the surgeon should strive to place a perpendicular hole from the clavicle to the coracoid process for suture-button fixation with TightRope to enable the successful reconstruction of acute AC-CC injury. Scheibel et al 19) utilized an image intensifier control during tunnel placement to prevent overdrilling as well as to control the location and entry points of the K-wires, thereby, minimizing the risk of K-wire and tunnel malpositioning. In a cadaver study, Hoffmann et al 22) utilized the electromagnetic navigation system for transclavicular-transcoracoid tunnel placement in minimally invasive arthroscopically assisted anatomic AC joint reconstruction.…”

Section: Discussionmentioning

confidence: 99%

All-arthroscopic, Guideless Single Suture-button Fixation of Acute Acromioclavicular Joint Dislocation: A Description of the Technique and Early Treatment Results

Altıntaş

Yıldız

Uzer

et al. 2017

Clinics in Shoulder and Elbow

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Background: The purpose of this study was to examine the clinical and radiological results of the all-arthroscopic, suture-button fixation technique to treat acute acromioclavicular (AC) joint separations. Methods: All patients with acute AC joint separations received all-arthroscopic, single suture-button (TightRope) procedure without a special guide. Postoperative Constant score (CS), pain level according to visual analogue scale, and range of motion (ROM) were evaluated. For radiological evaluation, coracoclavicular distances were measured bilaterally. Results: Between December 2010 and June 2012, 18 consecutive patients (4 women and 14 men; mean age, 29.3 years) with acute AC joint separations underwent surgical treatment after 6.4 days (range, 2-20 days) following the initial trauma. The average postoperative follow-up was 16.9 months. The mean CS was 92.4 (range, 84-96). The mean external rotation, forward flexion, and abduction were 75.8° (range, 50°-90°), 170° (range, 150°-180°), and 163.8° (range, 140°-180°), respectively. Five patients exhibited coracoclavicular ossifications. In two patients, superficial wound infections were successfully treated with antibiotic therapy. In one patient, a coracoid fracture was observed. No significant differences were found regarding pain, ROM, or strength parameters between both sides. The coracoclavicular distance was discovered to be approximately 2.8 mm greater on the affected side; however, this minimal reduction loss did not affect the functional results. Conclusions: The findings of this study suggests that all-arthroscopic treatment of AC joint separations using the single suture-button technique without a drill guide is safe, yielding good to excellent clinical results. (Clin Shoulder Elbow 2017;20(2):59-67)

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“…Dynamische, horizontale Instabilitäten werden nicht erfasst, was hinsichtlich der Operationsindikation einen Nachteil darstellt, da, wie bereits erwähnt, das klinische Outcome von Patienten mit überse-henen, verbliebenen horizontalen Instabilitäten signifikant schlechter ist [28].…”

Section: Klassifikation Der Schultereckgelenksprengungunclassified

“…Abb. 4, [9,22,27,28]). Zu beachten ist auch, dass die arthroskopisch gestützten anatomischen Verfahren nur in Spezialkliniken für Schulterchirurgie in nennenswerter Weise zum Einsatz kommen und innerhalb dieser Kliniken zudem auf wenige Operateure beschränkt sind.…”

Section: Hakenplatte Vs Fadenbasierte Stabilisierungunclassified

Hakenplatte noch Standard bei Akromioklavikulargelenksprengung?

Bökeler

Felenda

Liener

2014

Trauma Berufskrankh

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Verletzungen des Akromioklavikulargelenks (ACG) sind mit 9% aller Läsionen in diesem Bereich die häufigste Verletzung des Schultergürtels. Betroffen sind in erster Linie junge, sportlich aktive Män-ner zwischen dem 20. und 40. Lebensjahr [12,19]. Unfallmechanismus ist in erster Linie ein Sturz auf die superolaterale Region der Schulter, wobei die akromio-und korakoklavikularen Bänder verletzt werden [18].In der Literatur liegt weitgehend Einigkeit darüber vor, dass Verletzungen der Schweregrade Rockwood IV, V und VI operativ zu behandeln sind [4,26]. Uneinigkeit besteht weiterhin über die Therapie von Verletzungen des Grads Rockwood III [2,4,5,24], wobei hier in den letzten Jahren ein Trend zur konservativen Behandlung zu verzeichnen war [30].Wird eine operative Versorgung angestrebt, sollte diese frühelektiv durchgeführt werden, da bei verspäteter Versorgung die biologische Potenz des Gewebes abnimmt und dadurch schlechtere klinische Ergebnisse beobachtet wurden [26,32]. Die Zeitspanne zwischen dem Trauma und der Operation sollte daher mög-lichst kurz sein und 3 Wochen nicht über-schreiten [23]. Klinik und Diagnostik Hakenplatte vs. fadenbasierte StabilisierungZiel der folgenden Ausführung ist ein Vergleich der in Deutschland überwie-gend zum Einsatz kommenden Versorgung mittels Hakenplatte und der fadenbasierten Stabilisierung von ACG-Sprengungen.Bezüglich der reinen Implantatkosten sind beide Verfahren vergleichbar, reine Implantatkosten bei den Hakenplattenimplantationen lagen 2013 bei etwa 350,00 €, für eine TightRope®-Implantation (Firma Arthrex) bei etwa 305,00 €.In aktuellen Arbeiten wurden geringe Komplikations-und Reoperationsrate für die Versorgung mit "tight rope" angegeben, es fanden sich jedoch z. T. hohe Raten an heterotropen Ossifikationen, sekundärem Repositionsverlust und Implantatmigrationen (. Abb. 4,[9,22,27,28]). Zu beachten ist auch, dass die arthroskopisch gestützten anatomischen Verfahren nur in Spezialkliniken für Schulterchirurgie in nennenswerter Weise zum Einsatz kommen und innerhalb dieser Kliniken zudem auf wenige Operateure beschränkt sind.Der operative Aufwand ist zudem bei arthroskopischen Verfahren, im Vergleich zur Verwendung der Hakenplatte, deutlich erhöht. Diese Tatsachen stehen einem breiten klinischen Einsatz entgegen, der für die Behandlung dieser häu-

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Arthroscopically Assisted Stabilization of Acute High-Grade Acromioclavicular Joint Separations

Cited by 362 publications

References 15 publications

Arthroscopically Assisted Acromioclavicular and Coracoclavicular Ligament Reconstruction for Chronic Acromioclavicular Joint Instability

Arthroscopically Assisted Acromioclavicular and Coracoclavicular Ligament Reconstruction for Chronic Acromioclavicular Joint Instability

All-arthroscopic, Guideless Single Suture-button Fixation of Acute Acromioclavicular Joint Dislocation: A Description of the Technique and Early Treatment Results

Hakenplatte noch Standard bei Akromioklavikulargelenksprengung?

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