Vergleich und Ergebnis von Schultereckgelenkverletzungen II. und III. Grades

Abstract

Eighty-five patients with grade 2 or grade 3 sprains of the acromioclavicular (AC) joint were evaluated clinically and radiographically 32 months after injury. Group I included 34 patients with grade 2 sprains (Tossy II) and group II included 51 patients with grade 3 injuries (Tossy III). In group I, 15 patients were treated surgically (group Ia) and 19 patients were treated conservatively (group Ib), while in group II, 41 patients were treated surgically (group IIa) and 10 patients were treated conservatively (group IIb). At surgery open reduction and transarticular fixation of the AC joint with Kirschner wires was performed. Conservative treatment included the initial use of a sling or a knapsack bandage and early performance of range-of-motion exercises. Shoulder function was assessed according to the score devised by Constant and Murley. In both groups, 97 of 100 possible points (minimum 72, maximum 100) were obtained after conservative and after surgical treatment. Nine of 10 patients (90%) with grade 3 sprains (group IIb) had more pronounced displacement and increased mobility of the lateral end of the clavicle after conservative treatment. After surgery, dislocation and increased horizontal, mobility of the lateral end of the clavicle occurred in 18 (44%) of 41 patients with grade 3 sprains (group IIa P < 0.0001). However, these findings did not correlate with the functional outcome. At follow-up there was a significant increase in degenerative changes seen on radiographs (P < 0.035) in all patients. Again these findings did not correlate with the functional outcome. More degenerative radiological changes were observed in patients who had undergone surgery (P < 0.003). Patients with grade 2 sprains were more frequently restricted in sporting activity after surgery (P < 0.05). Patients with grade 3 sprains who were treated surgically complained of pain more frequently (P < 0.01), and they returned to work later than patients who were treated conservatively after grade 3 sprains. An additional rehabilitation program guided by a physiotherapist seemed to have no impact on the functional outcome. A total of 56 patients were treated by surgery. Among these patients 11 complications occurred, requiring five additional surgical procedures. Among 29 conservatively treated patients, only in 1 patient did subacromially located arthritic changes of the AC joint have to be removed.

Operative or conservative treatment in patients with Rockwood type III acromioclavicular dislocation: a systematic review and update of current literature

“…This suggests that a higher number of radiographic abnormalities in the surgical group might not be a valid argument for conservative treatment. This is in accordance with previous studies, which demonstrated that radiological abnormalities after surgery were often not clinically relevant in patients [2,23,[28][29][30][31].…”

Acromioclavicular Dislocations Type III

“…Clinical redislocations occur in 3-43% of the cases [9,12,14,26]. On X-rays, a subluxation is present in 17%, and 3% have a complete redislocation [9,10,26,27]. Our previous experiences have also shown that, if redislocation appears after operative treatment, the number of excellent and good results drops from 60% to 30% (p < 0.05; Figure 4) [20].…”

“…So, operative treatments do not guarantee maintenance of reduction. Clinical redislocations occur in 3-43% of the cases [9,12,14,26]. On X-rays, a subluxation is present in 17%, and 3% have a complete redislocation [9,10,26,27].…”

Konservative oder operative Therapie der Schultereckgelenkverletzung – was ist gesichert ? Eine systematische Literaturanalyse nach Kriterien der „evidence based medicine“

“…Zwei neuere Untersuchungen [29,32] wurden nach dem ¹constant scoreª durchgeführt. Obwohl die konservative Therapie in 9 der 10 Studien einheitlich in einer kurzzeitigen Ruhigstellung von 2±4 Wochen und anschlieûender funktioneller Therapie bestand, sind die operativen Verfahren sehr unterschiedlich.…”

“…Übereinstimmend wird in allen Nachuntersuchungen ein verbliebener Hochstand der lateralen Clavicula in bis zu 90 % nach konservativer Therapie angegeben [29]. In bis zu 44 % wurden diese Befunde auch nach operativer Therapie erhoben.…”