Dynamic instability of the acromioclavicular joint

Kraus, Natascha; Hann, Carmen; Gerhardt, Christian; Scheibel, Markus

doi:10.1007/s11678-018-0469-x

Cited by 31 publications

(27 citation statements)

References 15 publications

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“…Dynamic horizontal instability is considered to be the main reason for poor clinical outcome after both surgical and conservative treatments for ac joint instability 4,6,10,11,16 …”

Section: Discussionmentioning

confidence: 99%

Sonographic Measurement of Dynamic Horizontal Instability in Acromioclavicular Joint Instability

Bockmann

Venjakob²,

Thrasyvoulidis³

et al. 2021

J of Ultrasound Medicine

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Objective Dynamic horizontal instability is considered to be the main reason for poor outcome after treatment for acromioclavicular (AC) joint instability. In this study, we describe a simple technique to quantify this pathology via sonography. Methods Thirty‐six shoulders from 18 patients with ac joint instabilities were examined using modified Alexander views and a standardized sonographic examination. On the Alexander views, overlap of acromion and clavicle (OLAC), glenoid center to posterior clavicle distance (GCPC), and lateral extension (LE) were measured. Afterwards, the results were analyzed and compared with sonography. Posterior translation of the clavicle and the difference of translation between healthy and injured shoulder were evaluated. Results The mean age of the patients was 39 ± 14 years (range 19–61 years). We included 4 (22%) Rockwood type 3, 1 (6%) Rockwood type 4, and 13 (72%) Rockwood type 5 lesions. Four (22%) patients were female and 14 (78%) male patients. Posterior clavicle translation of the injured shoulder correlated strongly between OLAC and sonography (r = −0.514, P = .029), and the difference of translation between healthy and injured shoulder correlated very strongly between LE and sonography (r = 0.737, P < .001). Conclusion The sonographic measurement technique for horizontal instability presented in this work could help detect horizontal instabilities. While the observation of dynamic horizontal displacement is a strength of this technique, measurements are hindered in cases of high coracoclavicular distances. Level of Evidence Level III—retrospective cohort study.

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“…Dynamic horizontal instability is considered to be the main reason for poor clinical outcome after both surgical and conservative treatments for ac joint instability 4,6,10,11,16 …”

Section: Discussionmentioning

confidence: 99%

Sonographic Measurement of Dynamic Horizontal Instability in Acromioclavicular Joint Instability

Bockmann

Venjakob²,

Thrasyvoulidis³

et al. 2021

J of Ultrasound Medicine

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“…Die sog. dynamische posteriore Translation (DPT) [8] findet in dieser Klassifikation allerdings keine Berücksichtigung.…”

Section: Pathogeneseunclassified

“…In der Alexander-Aufnahme kann die DPT in nicht disloziert, partiell oder komplett disloziert unterteilt werden [8], wobei eine komplette DPT im Vergleich zu den anderen Möglichkeiten (nicht disloziert, partiell disloziert) mit schlechteren klinischen Scores nach akutem Trauma (< 3 Wochen nach Trauma) assoziiert ist [8].…”

Section: Pathogeneseunclassified

“…Die Akutsituation der ACG-Sprengung ist als ein Zeitraum von ca. 3 Wochen nach Trauma definiert [8,22], weil das ligamentäre Heilungspotenzial im Sinne einer stabilen Narbenbildung zeitlich beschränkt ist. Zu einem späteren Versorgungszeitpunkt ist gerade bei hochgradiger Instabilität eine biologische Augmentation erforderlich.…”

Section: Minimalinvasive Therapie Der Akuten Schultereckgelenksprengungunclassified

“…d Reposition und Verknotung.CME-FortbildungDieses Dokument wurde zum persönlichen Gebrauch heruntergeladen. Vervielfältigung nur mit Zustimmung des Verlages.Neuerungen zur Stabilisation der akuten ACG-InstabilitätDie isolierte CC-Stabilisierung mit Doppel-Button-Verfahren zeigte zufriedenstellende klinische Ergebnisse, jedoch verblieb häufig eine DPT, die mit schlechteren klinischen Ergebnissen einherging[8]. Aus diesen Beobachtungen resultierte die Einführung der additiven horizontalen Stabilisierung (z.…”

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Minimalinvasive Techniken zur Therapie der Schultereckgelenksprengung

Vetter¹,

Eckl²,

Bellmann³

et al. 2023

Z Orthop Unfall

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Clavicular tunnel widening in chronic acromioclavicular joint instabilities after primary versus revision arthroscopically‐assisted acromio‐ and coracoclavicular stabilization

Vetter,

Bellmann,

Eckl

et al. 2024

J. exp. orthop.

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PurposeTo evaluate joint reduction (loss of reduction [LOR]; dynamic posterior translation [DPT]) and clavicular tunnel widening (cTW) in patients treated with arthroscopically‐assisted acromioclavicular joint (ACJ) stabilization after previously failed nonoperative versus surgical treatment.MethodsPatients undergoing arthroscopically‐assisted ACJ stabilization (bidirectional tendon allograft with a low‐profile TightRope) after previously failed nonoperative versus surgical treatment were included retrospectively. Bilateral anteroposterior stress views served for evaluating LOR (side‐comparative coracoclavicular distance [CCD]) and cTW at a 6‐weeks‐ and 6‐months‐follow‐up (FU) and for evaluating the filling ratio (FR, vertical device insertion depth relative to clavicle height) at the 6‐weeks‐FU. Postoperative DPT was assessed on Alexander's views.ResultsTwenty‐seven patients (20 male, mean age 46.1 ± 14.8 years) were included (prior treatment: nonoperative: n = 15; surgical: n = 12). There were no differences in LOR, DPT or cTW between groups postoperatively. Initial CCD‐symmetry at the 6‐weeks‐FU (CCD: −0.1 mm [95% confidence interval, CI, −2 to 1.4 mm]) was followed by LOR at the 6‐months‐FU (CCD: −3.5 mm [95% CI, −5.2 to −1.9 mm]; p < 0.001). cTW increased towards the inferior cortex, compared to the superior cortex and the intermediate level (p < 0.001, respectively). cTW at the inferior cortex was associated with more LOR (r = −0.449; p = 0.024) and DPT (r = 0.421; p = 0.036), dependent on a smaller FR (r = −0.430; p = 0.032).ConclusionPatients undergoing arthroscopically‐assisted ACJ stabilization for chronic bidirectional ACJ instabilities showed comparable radiologic results after previous nonoperative versus surgical treatment. cTW increased towards the inferior cortex and was associated with recurrent vertical and horizontal instability, related to a smaller FR. More research into reduced cTW, for example, by a more filling device, should be performed.Level of EvidenceLevel III, retrospective comparative study.

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Dynamic instability of the acromioclavicular joint

Cited by 31 publications

References 15 publications

Sonographic Measurement of Dynamic Horizontal Instability in Acromioclavicular Joint Instability

Sonographic Measurement of Dynamic Horizontal Instability in Acromioclavicular Joint Instability

Minimalinvasive Techniken zur Therapie der Schultereckgelenksprengung

Clavicular tunnel widening in chronic acromioclavicular joint instabilities after primary versus revision arthroscopically‐assisted acromio‐ and coracoclavicular stabilization

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