Natascha Kraus

Arthroscopically Assisted Stabilization of Acute High-Grade Acromioclavicular Joint Separations

Background: The purpose of this study was to evaluate the clinical and radiological results after arthroscopically assisted and image intensifier–controlled stabilization of high-grade acromioclavicular (AC) joint separations using the double TightRope technique with the first-generation implant. Hypothesis: The double TightRope technique using the first-generation implant leads to good clinical and radiological results by re-creating the anatomy of the AC joint. Study Design: Case series; Level of evidence, 4. Methods: Thirty-seven consecutive patients (4 women and 33 men; mean age, 38.6 years) who sustained an acute AC joint dislocation grade V according to Rockwood were included in this prospective study. The Subjective Shoulder Value (SSV), the Constant Score (CS), the Taft Score (TS), and a newly developed Acromioclavicular Joint Instability Score (ACJI) were used for final follow-up. Bilateral stress views and bilateral Alexander views were taken to evaluate radiographic signs of recurrent vertical and horizontal AC joint instability. Results: Twenty-eight patients (2 women and 26 men; mean age, 38.8 years [range, 18-66 years]) could be evaluated after a mean follow-up of 26.5 months (range, 20.1-32.8 months). The interval from trauma to surgery averaged 7.3 days (range, 0-18 days). The mean SSV reached 95.1% (range, 85%-100%), the mean CS was 91.5 points (range, 84-100) (contralateral side: mean, 92.6 points), the mean TS was 10.5 points (range, 7-12), and the ACJI averaged 79.9 points (range, 45-100). The final coracoclavicular distance was 13.6 mm (range, 5-27 mm) on the operated versus 9.4 mm (range, 4-15 mm) on the contralateral side (P < .05). Radiographic signs of posterior instability were noted in 42.9% of cases. Patients with evidence of posterior instability had significantly inferior results in the TS and the ACJI (P < .05). Neither coracoid fractures nor early (within 6 weeks postoperatively) loss of reduction due to tunnel malpositioning or implant loosening was observed. Conclusion: The combined arthroscopically assisted and image intensifier–controlled double TightRope technique using implants of the first-generation represents a safe technique and yields good to excellent early clinical results despite the presence of partial recurrent vertical and horizontal AC joint instability.

Arthroscopic reconstruction of chronic anteroinferior glenoid defect using an autologous tricortical iliac crest bone grafting technique

Only a few reports exist on the management of severe anteroinferior glenoid defects in case of recurrent shoulder instability most of them including open approaches. We describe an all-arthroscopic reconstruction technique of the anteroinferior glenoid that includes an autologous iliac crest bone grafting using bio-compression screws and a capsulolabral repair using suture anchors. This technique recreates the bony and soft-tissue anatomy of the anteroinferior glenoid while preserving the integrity of insertion of the subscapularis (SSC) tendon.

Prevalence and pattern of glenohumeral injuries among acute high-grade acromioclavicular joint instabilities.

BACKGROUND With increasing numbers of arthroscopically assisted acromioclavicular (AC) joint stabilization procedures has come an increase in reports of concomitant glenohumeral injuries among AC joint separations. The aim of the present study was to evaluate the prevalence, pattern, and cause of glenohumeral pathologies among a large patient population with acute high-grade AC joint instability. MATERIALS AND METHODS A total of 125 patients (13 women, 112 men) with high-grade AC joint dislocation (6 Rockwood II; 119 Rockwood V) underwent diagnostic glenohumeral arthroscopy before AC joint repair. Pathologic lesions were evaluated for acute or degenerative origin and, if considered relevant, treated all-arthroscopically. RESULTS Concomitant glenohumeral pathologies were found in 38 of 125 patients (30.4%). Analysis of pathogenesis distinguished different patterns of accompanying injuries: acute intra-articular lesions, related to the recent shoulder trauma, were found in 9 patients (7.2%), degenerative lesions, considered to be unrelated to the recent trauma, were found in 18 (14.4%), and 11 (8.8%) had an unclear traumatic correlation (intermediate group). Within the acute and the degenerative group, affected structures were predominantly partial, articular-sided tears of the anterosuperior rotator cuff, including instabilities of the pulley complex, followed by pathologies of the long head of the biceps and superior labrum anteroposterior lesions. The intermediate group presented mainly with articular-sided partial tears of the subscapularis tendon. CONCLUSIONS This prospective study showed a high prevalence (30%) of concomitant glenohumeral pathologies, of which some indicate additional surgical therapy and could be missed by an isolated open AC repair. Hence, the arthroscopic approach for AC joint stabilization allows for the diagnosis and treatment of associated intra-articular pathologies.

Subjective and Objective Outcome After Revision Arthroscopic Stabilization for Recurrent Anterior Instability Versus Initial Shoulder Stabilization

Background: The value of arthroscopic revision shoulder stabilization after failed instability repair is still a matter of debate. Hypothesis: Arthroscopic revision shoulder stabilization using suture anchors provides equivalent subjective and objective results compared with initial arthroscopic instability repair. Study Design: Cohort study; Level of evidence, 3. Methods: Twenty consecutive patients who underwent arthroscopic revision shoulder stabilization using suture anchors (group 2) were matched for age, gender, and handedness (dominant or nondominant) with 20 patients who had initial arthroscopic instability repair using the same technique (group 1). At the time of follow-up, a complete physical examination of both shoulders and evaluation with the Rowe score, Walch-Duplay score, Melbourne Instability Shoulder Score, Western Ontario Shoulder Instability Index, and the Subjective Shoulder Value were performed. In addition, standard radiographs (true AP and axillary views) were taken to evaluate signs of osteoarthritis. Results: After a minimum follow-up of 24 months, no recurrent dislocations were observed in either group. The apprehension sign was positive in 2 cases of revision surgery (0 vs 2; P > .05). No significant differences in the Rowe score (89 vs 81.8 points) were found between groups 1 and 2 (P > .05). However, group 2 revealed significantly lower scores in the Walch-Duplay score (85.3 vs 75.5 points), Melbourne Instability Shoulder Score (90.2 vs 73.7 points), Western Ontario Shoulder Instability Index (89.8% vs 68.9%), and Subjective Shoulder Value (91.8% vs 69.2%) (P < .05). Signs of instability arthropathy were found more often in patients with arthroscopic revision surgery (2 vs 5; P > .05). Conclusion: Arthroscopic revision shoulder stabilization is associated with a lower subjective outcome compared with initial arthroscopic stabilization. The objective results found in this study may overestimate the clinical outcome in this patient population.

Anterior glenoid rim defects of the shoulder

Bony instability of the shoulder due to glenoid defects has recently received increasing attention. Glenoid defects can be divided into acute fragment-type lesions (type I), chronic fragment-type lesions (type II) and glenoid bone loss without a bony fragment (type III). The diagnosis and classification are mainly based on imaging methods including a radiographic instability series and/or computed tomography. The management of anterior glenoid rim lesions depends on many factors including the clinical presentation, type of lesion, concomitant pathology as well as age and functional demands of the patient. If bony-mediated instability is present, surgery is indicated. In the majority of cases fragment-type lesions can be successfully treated using either arthroscopic or open reconstruction techniques.Small erosion-type lesions can also be managed via soft-tissue procedures, whereas large erosion-type lesions with significant bone loss may necessitate bone-grafting procedures (autologous iliac crest or coracoid transfer) to restore glenoid concavity and shoulder stability. Although glenoid bone grafting is usually performed via an open approach, recent clinical studies have shown that it can be successfully managed by advanced arthroscopic techniques.

Anteriore Glenoidranddefekte der Schulter

Bony instability of the shoulder due to glenoid defects has recently received increasing attention. Glenoid defects can be divided into acute fragment-type lesions (type I), chronic fragment-type lesions (type II) and glenoid bone loss without a bony fragment (type III). The diagnosis and classification are mainly based on imaging methods including a radiographic instability series and/or computed tomography. The management of anterior glenoid rim lesions depends on many factors including the clinical presentation, type of lesion, concomitant pathology as well as age and functional demands of the patient. If bony-mediated instability is present, surgery is indicated. In the majority of cases fragment-type lesions can be successfully treated using either arthroscopic or open reconstruction techniques.Small erosion-type lesions can also be managed via soft-tissue procedures, whereas large erosion-type lesions with significant bone loss may necessitate bone-grafting procedures (autologous iliac crest or coracoid transfer) to restore glenoid concavity and shoulder stability. Although glenoid bone grafting is usually performed via an open approach, recent clinical studies have shown that it can be successfully managed by advanced arthroscopic techniques.

Arthroscopic anatomic glenoid reconstruction using an autologous iliac crest bone grafting technique

BACKGROUND Open bone block procedures for glenohumeral stabilization have been used for a long time. With the advancement of arthroscopic techniques and the development of sophisticated instruments and implants, the insertion of the bone block can be performed by an all-arthroscopic approach. The purpose of this study was to evaluate the clinical and radiologic results after an arthroscopic anatomic glenoid reconstruction using an all-arthroscopic, autologous tricortical iliac crest bone grafting technique. MATERIALS AND METHODS Fifteen patients (1 female and 14 male patients; mean age, 31.4 years [range, 17-49 years]) underwent reconstruction of significant glenoid defects in cases of recurrent shoulder instability by the aforementioned technique. The patients were followed up clinically (range of motion, Constant score, Rowe score, Subjective Shoulder Value, and Western Ontario Shoulder Instability Index) and radiographically (with true anteroposterior and axillary views, as well as 2-/3-dimensional computed tomography [glenoid configuration, signs of graft resorption, bone consolidation, and glenoid index]). RESULTS After a mean follow-up period of 20.6 months (range, 12-65 months), the Constant score averaged 85.0 points (range, 73-98 points; contralateral side, 89.6 points [range, 78-96 points]), the Rowe score averaged 88.0 points (range, 65-100 points), the Subjective Shoulder Value averaged 84.5% (range, 50%-100%), and the Western Ontario Shoulder Instability Index averaged 76.7% (range, 46%-93%). No recurrent subluxations or dislocations were observed. Radiographically, computed tomography imaging showed a consolidated autograft in all cases. The glenoid index increased from a mean of 0.77 preoperatively to 1.16 immediately postoperatively; at the time of last follow-up, the glenoid index decreased to 1.04. CONCLUSION The arthroscopic reconstruction of anteroinferior glenoid defects re-creates the pear-shaped anatomy of the anteroinferior glenoid and leads to good to excellent early clinical results.

Arthroscopic stabilization of acute acromioclavicular joint dislocation

ZusammenfassungIn den letzten Jahren haben arthroskopische bzw. minimalinvasive Techniken zur Therapie von Schultereckgelenksprengungen zunehmend Verbreitung gefunden. Zum einen wurden etablierte Verfahren der offenen Chirurgie modifiziert und auf ein arthroskopisches Niveau angehoben. Zum anderen sind neue Implantate entwickelt worden, die es ermöglichen, rekonstruktive Techniken rein arthroskopisch unter Aufhebung der Nachteile der offenen Verfahren durchzuführen. Die bisher beschriebenen kurz- bis mittelfristigen Resultate dieser arthroskopischer Verfahren sind den offenen Verfahren hinsichtlich der klinischen und radiologischen Ergebnisse mindestens ebenbürtig.AbstractDuring the past few years arthroscopic and minimal invasive techniques for stabilization of acromioclavicular (AC) joint dislocations have gained increasing interest. Well established procedures for open surgery were modified and implemented to attain an arthroscopic level. Furthermore implants were developed which enable these reconstructive techniques to be performed arthroscopically without the disadvantages of open procedures. The short to mid-term results described so far concerning the clinical and radiological outcome of arthroscopic stabilization techniques show an at least equal outcome to those presented in open surgery.During the past few years arthroscopic and minimal invasive techniques for stabilization of acromioclavicular (AC) joint dislocations have gained increasing interest. Well established procedures for open surgery were modified and implemented to attain an arthroscopic level. Furthermore implants were developed which enable these reconstructive techniques to be performed arthroscopically without the disadvantages of open procedures. The short to mid-term results described so far concerning the clinical and radiological outcome of arthroscopic stabilization techniques show an at least equal outcome to those presented in open surgery.

Arthroskopische Stabilisierung der akuten Schultereckgelenksprengung

ZusammenfassungIn den letzten Jahren haben arthroskopische bzw. minimalinvasive Techniken zur Therapie von Schultereckgelenksprengungen zunehmend Verbreitung gefunden. Zum einen wurden etablierte Verfahren der offenen Chirurgie modifiziert und auf ein arthroskopisches Niveau angehoben. Zum anderen sind neue Implantate entwickelt worden, die es ermöglichen, rekonstruktive Techniken rein arthroskopisch unter Aufhebung der Nachteile der offenen Verfahren durchzuführen. Die bisher beschriebenen kurz- bis mittelfristigen Resultate dieser arthroskopischer Verfahren sind den offenen Verfahren hinsichtlich der klinischen und radiologischen Ergebnisse mindestens ebenbürtig.AbstractDuring the past few years arthroscopic and minimal invasive techniques for stabilization of acromioclavicular (AC) joint dislocations have gained increasing interest. Well established procedures for open surgery were modified and implemented to attain an arthroscopic level. Furthermore implants were developed which enable these reconstructive techniques to be performed arthroscopically without the disadvantages of open procedures. The short to mid-term results described so far concerning the clinical and radiological outcome of arthroscopic stabilization techniques show an at least equal outcome to those presented in open surgery.During the past few years arthroscopic and minimal invasive techniques for stabilization of acromioclavicular (AC) joint dislocations have gained increasing interest. Well established procedures for open surgery were modified and implemented to attain an arthroscopic level. Furthermore implants were developed which enable these reconstructive techniques to be performed arthroscopically without the disadvantages of open procedures. The short to mid-term results described so far concerning the clinical and radiological outcome of arthroscopic stabilization techniques show an at least equal outcome to those presented in open surgery.

Arthroskopische Pfannenrandrekonstruktion mit autologer Spanplastik

ZusammenfassungOffene Knochenblockverfahren werden seit langem in unterschiedlichen Variationen zur Behandlung der Schultergelenkinstabilität verwendet. Kürzlich publizierte klinische und radiologische Arbeiten konnten zeigen, dass eine anatomische Rekonstruktionstechnik mit Wiederherstellung der glenoidalen Konkavität durch einen präformierten Beckenspan eine effektive und dauerhafte Methode zur Behandlung knöchern bedingter vorderer Schulterinstabilitäten darstellt. Die Weiterentwicklung arthroskopischer Techniken und die Neuentwicklung von Implantaten bzw. Instrumenten ermöglichen eine komplett arthroskopische Apposition des Knochenblocks. Diese Arbeit beschreibt die historische Entwicklung, Grundlagen, Indikationen, die operative Technik und Frühergebnisse der arthroskopischen Beckenspanplastik.AbstractOpen bone block procedures for glenohumeral stabilization have been used for a long time in different variations. Recently published clinical and radiological studies were able to demonstrate that anatomical reconstruction of the glenoid concavity using a pre-shaped iliac crest autograft represents an effective and durable treatment option for bony-mediated anterior shoulder instability. With the advancement of arthroscopic techniques and the development of sophisticated instruments and implants apposition of the bone block can now be performed via an all-arthroscopic approach. This article describes the history, principles, indications, surgical technique and early results of the all-arthroscopic iliac crest bone block procedure.Open bone block procedures for glenohumeral stabilization have been used for a long time in different variations. Recently published clinical and radiological studies were able to demonstrate that anatomical reconstruction of the glenoid concavity using a pre-shaped iliac crest autograft represents an effective and durable treatment option for bony-mediated anterior shoulder instability. With the advancement of arthroscopic techniques and the development of sophisticated instruments and implants apposition of the bone block can now be performed via an all-arthroscopic approach. This article describes the history, principles, indications, surgical technique and early results of the all-arthroscopic iliac crest bone block procedure.