Glenohumerale Begleitpathologien bei höhergradigen Schultereckgelenksverletzungen (Typ Rockwood III - V) : Eine retrospektive Datenanalyse

Glenohumeral injuries are a common epiphenomenon during acromioclavicular separation. The increas-ing use of minimally invasive techniques allows for an easier diagnosis and simultaneous treatment of concomitant pathologies. The aim of this dissertation is to identify the incidence of concomitant intraar-ticular injuries in patients with high-grade acromioclavicular separation (Rockwood III – V) as well as to reveal potential risk constellations. Material and Methods This study was conducted in the Department of Trauma Surgery of the Universitätsklinikum Marburg between the years 2009 and 2015. 163 patients (147 male; 16 female; mean age 36.8 years) suffering from high-grade acromioclavicular separation (Rockwood III: n = 60; Rockwood IV: n = 6; Rockwood V: n = 97) underwent arthroscopically assisted treatment during which the pathologies were compiled. The obtained data was analyzed descriptively, statistically and the causality of the concomitant pathologies was attributed to three factors (acute, intermediate and degenerative causes). Several subgroup anal-yses concerning the severity of the AC-separation, the sex of the patient and the age were conducted. Results Men were more likely to having suffered an acromioclavicular separation (p < 0,001). Rockwood V inju-ries were observed significantly more often than the other grades (p = 0,015). Concomitant pathologies were found in 39.3 % (n = 64) of the patients with an average of 1.9 injuries per patient. The incidence of rotator cuff injuries accounted for 32.3 % (n = 40) of the concomitant injuries. Chondral defects were diagnosed in 30.6 % (n = 38), SLAP-lesions in 22.6 % (n = 28). Accompanying pathologies were attributed to degeneration in 70.0 % (n = 42) of the cases. 21.9 % (n = 14) of all patients with accompanying injuries needed reconstructive surgery. The subgroup analysis showed no difference concerning etiology, kind and frequency of concomitant injuries during AC-separation between the sexes and between the differ-ent Rockwood grades. 57.3 % (n = 43) of the patients above 35 years incurred a concomitant injury dur-ing acromioclavicular separation. A higher incidence of accompanying pathologies also correlated with a higher age (p < 0,001). Specific concomitant pathologies in this subgroup were SLAP-lesions (p < 0,001), lesions of the M. subscapularis (p < 0,001), injuries of the long head of the biceps tendon (p = 0,002) and glenoidal chondral defects (p = 0,029). All pathologies in the age group above 35 years were significantly more likely to have been degenerative (p < 0,001). Younger patients were far more likely to have suf-fered the AC-separation during sports. The incidence of concomitant injuries in acromioclavicular separation has been underestimated so far. In almost 40 percent of all patients with ACJ-dislocation a concomitant injury could be diagnosed during a diagnostic arthroscopy. In the age group above 35 years the incidence of an accompanying injury rose to 57.3 %. Most commonly diagnosed pathologies were rotator cuff injuries, SLAP-lesions and chondral defects. 70 % of all concomitant injuries could be attributed to a mostly degenerative etiology. Preemi-nent risk group to having suffered an accompanying injuries were patients above 35 with preexisting degenerative defects. 8.6 % of all patients with acromioclavicular separation needed additional recon-structive surgery to address the concomitant pathology. Because of directly posttraumatic unspecific clinical symptoms risk group patients should undergo addi-tional diagnostic procedures (i.e. MRI, Medical Ultrasound). With indication for surgery an arthroscopi-cally assisted treatment of the acromioclavicular separation allows for an easier diagnosis and simulta-neous treatment of concomitant injuries and potentially reduces sick time compared to the existing open operation techniques.