Abstract
Aim
The aim of this study was to compare the short-term outcomes of arthroscopic TightRope® fixation with that of hook plate fixation in patients with acute unstable acromioclavicular joint dislocations.
Patients and methods
We conducted a prospective case–control study of twenty-six patients with an acute ACJ dislocation who underwent surgical repair with either an arthroscopic TightRope® fixation or a hook plate from 2013 to 2016. Clinical and radiological data were collected prospectively. Clinical outcomes were evaluated using the Constant Score, the University of California at Los Angeles (UCLA) Shoulder Score, Oxford Shoulder Score as well as the visual analogue scale. Radiological outcomes were assessed with the coracoclavicular distance (CCD).
Results
Sixteen patients underwent arthroscopic TightRope® fixation, while 10 patients underwent hook plate fixation. There were no significant differences in the preoperative variables except for the mean UCLA 4b infraspinatus score (TightRope® 2.8 vs. hook plate 3.8; p = 0.030). Duration of surgery was significantly longer in the TightRope® group. At 1 year post-operatively, the TightRope® group had a significantly better Constant Score and CCD with no complications. All patients with hook plate fixation had to undergo a second procedure for removal of implant, and 3 patients had complications.
Conclusions
Arthroscopic TightRope® fixation is a good option for the treatment of acute unstable ACJ dislocations. It has better short-term clinical and radiological outcomes as well as lesser complications when compared to hook plate fixation.
Level of evidence
Therapeutic, Level III.
Similar content being viewed by others
References
Oussedik S (2007) Injuries to the clavicle and acromioclavicular joint. Br J Hosp Med 68:M68–M70
Willimon S, Gaskill T, Millett P (2011) Acromioclavicular joint injuries: anatomy, diagnosis, and treatment. Phys Sport 39:116–122
Rieser G, Edwards K, Gould G et al (2013) Distal-third clavicle fracture fixation: a biomechanical evaluation of fixation. J Shoulder Elbow Surg 22:848–855
Rockwood C, Williams G, Young D (1996) Fractures in Adults, vol I, 4th edn. Lippincott-Raven, Philadelphia
Phillips A, Smart C, Groom A (1998) Acromioclavicular dislocation: conservative or surgical therapy. Clin Orthop Relat Res 353:10–17
Spencer EJ (2007) Treatment of grade III acromioclavicular joint injuries: a systematic review. Clin Orthop Relat Res 455:38–44
Hoffler C, Karas S (2010) Transacromial erosion of a locked subacromial hook plate: case report and review of literature. J Shoulder Elbow Surg 19:e12–e15
Bannister G, Wallace W, Stableforth P, Hutson M (1989) The management of acute acromioclavicular dislocation: a randomised prospective controlled trial. J Bone Jt Surg Br 71:848–850
Johansen J, Grutter P, McFarland EG, Petersen SA (2011) Acromioclavicular joint injuries: indications for treatment and treatment option. J Shoulder Elbow Surg 20:S70–S82
Simovitch R, Sanders B, Ozbaydar M et al (2009) Acromioclavicular joint injuries: diagnosis and management. J Am Acad Orthop Surg 17:207–219
von Heideken J, Bostrom Windhamre H, Une-Larsson V, Ekelund A (2013) Acute surgical treatment of acromioclavicular dislocation type V with a hook plate: superiority to late reconstruction. J Shoulder Elbow Surg 22:9–17
Nuchtern J, Sellenschloh K, Bishop N et al (2013) Biomechanical evaluation of 3 stabilization methods on acromioclavicular joint dislocations. Am J Sport Med 41:1387–1394
Mares O, Luneau S, Staquet V et al (2010) Acute grade III and IV acromioclavicular dislocations: outcomes and pitfalls of reconstruction procedures using a synthetic ligament. Orthop Traumatol Surg Res 96:721–726
Constant C, Murley A (1987) A clinical method of functional assessment of the shoulder. Clin Orthop Relat Res 214:160–164
Amstutz H, Sew Hoy A, Clarke I (1981) UCLA anatomic total shoulder arthroplasty. Clin Orthop Relat Res 155:7–20
Dawson J, Fitzpatrick R, Carr A (1996) Questionnaire on the perceptions of patients about shoulder surgery. J Bone Joint Surg Br 78:593–600
Hawker G, Mian S, Kendzerska T, French M (2011) Measures of adult pain: visual analog scale for pain (VAS pain), numeric rating scale for pain (NRS pain), McGill pain questionnaire (MPQ), short-form McGill pain questionnaire (SF-MPQ), chronic pain grade scale (CPGS), short form-36 bodily pain scale (SF. Arthritis Care Res 63(Suppl):S240–S252
Spoliti M, De Cupis M, Via A, Oliva F (2015) All arthroscopic stabilization of acute acromioclavicular joint dislocation with fiberwire and endobutton system. Muscles Ligaments Tendons J 4:398–403
Tischer T, Salzmann GM, El-Azab H et al (2008) Incidence of associated injuries with acute acromioclavicular joint dislocations types III through V. Am J Sports Med 37:136–139. https://doi.org/10.1177/0363546508322891
Jensen G, Kathagen J, Alvarado L et al (2014) Has the arthroscopically assisted reduction of acute AC joint separations with the double tight-rope technique advantages over the clavicular hook plate fixation? Knee Surg Sports Traumatol Arthrosc 22:422–430
Arirachakaran A, Boonard M, Piyapittayanum P et al (2016) Comparison of surgical outcomes between fixation with hook plate and loop suspensory fixation for acute unstable acromioclavicular joint dislocation: a systematic review and meta-analysis. Eur J Orthop Surg Traumatol 26:565–574
Jensen G, Ellwein A, Voigt C, Kathagen J (2015) Injuries of the acromioclavicular joint: hook plate verses arthroscopy. Unfallchirurg 118:1041–1053
Ludewig P, Braman J (2011) Shoulder impingement: biomechanical considerations in rehabilitation. Man Ther 16:33–39
Spencer H, Hsu L, Sodl J et al (2016) Radiographic failure and rates of re-operation after acromioclavicular joint reconstruction: a comparison of surgical techniques. Bone Joint J 98-B:512–518
Yoon J, Le B, Nam S et al (2015) Comparison of results between hook plate fixation and ligament reconstruction for acute unstable acromioclavicular joint dislocation. Clin Orthop Surg 7:97–103
Lin H, Wong P, Ho W et al (2014) Clavicular hook plate may induce subacromial shoulder impingement and rotatr cuff lesion-dyanamic sonographic evaluation. J Orthop Surg Res 9:6
Natera Cisneros L, Sarasquete Reiriz J (2017) Acute high-grade acromioclavicular joint injuries: quality of life comparison between patients managed operatively with a hook plate versus patients managed non-operatively. Eur J Orthop Surg Traumatol 27:341–350
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
All authors declare that they have no conflict of interest.
Rights and permissions
About this article
Cite this article
Bin Abd Razak, H.R., Yeo, EM.N., Yeo, W. et al. Short-term outcomes of arthroscopic TightRope® fixation are better than hook plate fixation in acute unstable acromioclavicular joint dislocations. Eur J Orthop Surg Traumatol 28, 869–875 (2018). https://doi.org/10.1007/s00590-017-2095-5
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00590-017-2095-5