Background Treatment of acute (B3 weeks) acromioclavicular joint dislocation type III-VI is still controversial. Currently, the two modern techniques that are widely used are hook plate (HP) fixation and coracoclavicular ligament fixation using a suspensory loop device that consists of either a tightrope (single or double), endo-button (single or double), or synthetic ligament and absorbable polydioxansulfate sling. Materials and methods This systematic review was conducted according to the PRISMA guidelines. Relevant studies that reported Constant-Murley score (CMS), Pain Visual Analog score (VAS) and postoperative complications of either technique were identified from Medline and Scopus from inception to 5 October 2015. Results Sixteen studies were included for the analysis of HP fixation, and 25 studies were included for analysis of loop suspensory fixation (LSF). Pooling of mean CMS and VAS scores gave 90.35 (95% CI 87.16, 93.54), 1.51 (95% CI 0.73, 2) in the HP group, and 92.48 (95% CI 90.91, 94.05), 0.32 (95% CI 0, 0.64) in the suspensory loop devices group, respectively. The pooled unstandardized mean differences (UMD) scores of CMS and VAS in LSF were 2.13 (95% CI -1.43, 5.69) and -1.19 (95% CI -2.03, -0.35) when compared to hook plating. The pooled prevalence of LSF and hook plating were 0.08 (95% CI 0.06, 0.10) and 0.05 (95% CI 0.02, 0.08) scores. The chance of having complications in the LSF group was 1.69 (95% CI 1.07, 2.60), which was statistically significantly higher than in the HP group. Conclusion LSF have higher shoulder function scores (CMS) and lower postoperative pain when compared to HP fixation; however, there are higher complication rates with LSF when compared to hook plating. Level of evidence IV.

I.

Treatment of acute (≤4 weeks) high-grade acromioclavicular (AC) joint separation (types III-VI) is still controversial. Currently, the two modern techniques that are widely used include hook plate fixation and coracoclavicular (CC) ligament fixation using a suspensory loop device (tightrope, synthetic ligament or absorbable polydioxansulfate sling). These techniques are both reported to have superior clinical outcomes. This systematic review and meta-analysis aimed to assess and compare clinical outcomes of hook plate fixation versus fixation of the CC ligament using a loop suspensory fixation (LSF) device for the treatment of AC joint injury. These clinical outcomes consist of the Constant-Murley score (CMS), pain visual analog score (VAS) and postoperative complications. Relevant comparative studies were identified from MEDLINE and Scopus from inception to October 5, 2015. Five of 571 studies were eligible; 5, 3, 3, and 5 studies were included in the pooling of CMS, pain VAS, surgical time and postoperative complications, respectively. The unstandardized mean difference (UMD) of the CMS for LSF was 4.43 [95 % confidence interval (CI) 0.73, 8.14], which was statistically significantly higher than the CMS in hook plate fixation. For VAS, the UMD was 0.02 points (95 % CI -3.54, 3.73) higher than LSF but without statistical significance. The surgical time of LSF was 16.21 min (95 % CI 6.27, 26.15) statistically significantly higher than hook plate fixation. LSF had a lower chance of postoperative complications by 0.62 units (95 % CI 0.30, 1.32) when compared to hook plate fixation, but this also was not statistically significant. In acute high-grade AC joint injuries, loop suspensory fixation had higher postoperative functional CMS and mean surgical time when compared to hook plate fixation. However, for postoperative VAS and complication rates, there were no statistically significant differences between groups.

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In all, 117 of 493 studies were eligible and 32 studies (2,013 shoulders) and 11 studies (1,498 shoulders) were evaluated with MRA and MRI. The summary sensitivity, specificity, likelihood ratio (positive and negative) and AUROC were 0.87 (95 % confidence interval, CI: 0.82, 0.91), 0.92 (95 %CI: 0.85, 0.95), 10.28 (95 %CI: 5.84, 18.08), 0.14 (95 %CI: 0.10, 0.20) and 0.94 (95 %CI: 0.92, 0.96) respectively for MRA, and 0.76 (95 %CI: 0.61, 0.86), 0.87 (95 %CI: 0.71, 0.95), 5.89 (95 %CI: 2.5, 13.86), 0.28 (95 %CI: 0.17, 0.47) and 0.94 (95 %CI: 0.92, 0.96) respectively for MRI. The diagnostic performance of MRA was superior to MRI by both direct and indirect comparisons for the detection of SLAP lesions.