Biologic and synthetic ligament reconstructions achieve better functional scores compared to osteosynthesis in the treatment of acute acromioclavicular joint dislocation

Abstract

Purpose To systematically review the outcomes of surgical treatments of acute acromioclavicular joint dislocation. Methods Studies were identified by electronic databases (Ovid, PubMed). All studies reporting functional and radiological outcomes of surgical treatments of acute acromioclavicular joint dislocations were included. Following data were extracted: authors and year, study design, level of evidence, number of patients, age, classification of acromioclavicular joint dislocation, time to surgery, surgical technique, follow-up, clinical and imaging outcomes, complications, and failures. Descriptive statistics was used, when a data pooling was not possible. Comparable outcomes were pooled to generate summary outcomes reported as frequency-weighted values. Quality appraisal was assessed through the MINORS checklist. Results One hundred and thirty-three studies were included for a total of 4473 shoulders. Mean age of participants was 36.9 years. Mean follow-up was 42.06 months. Arthroscopy showed better ASES (p < 0.0001) and lower VAS pain score (p = 0.0249) compared to an open approach. Biologic and synthetic reconstructions demonstrated better results over osteosynthesis techniques. Biologic techniques showed overall better Constant (p = 0.0001) and DASH (p = 0.0215) scores, while synthetic reconstruction showed better UCLA score (p = 0.0001). Among suture buttons, triple button showed overall better results in Constant (p = 0.0001) and VAS (p = 0.0001) scores, while better results in DASH score (p = 0.0003) were achieved by 2 double button techniques. Overall, the level of evidence was low. Conclusion Biological and synthetic reconstructions achieved better functional scores compared to osteosynthesis. Among suture buttons, the triple button showed better functional performance. Level of evidence IV.

Bipolar clavicular dislocation treated with biological anatomical repair and reconstruction: A case report with a literature review of management options

“… 26 The use of autologous hamstring graft is an established method for CC ligament reconstruction, however it may be modified depending upon the timing of surgery and graft size availability. 28 Recently, the use of allograft has been quite popular, but its widespread use is restricted depending upon an availability. 29 …”

Does coracoclavicular augmentation additional to hook plate fixation provide benefits in acute unstable acromioclavicular dislocation? A meta-analysis

“…Various treatment options for acute unstable ACJ dislocation, such as CC fixation (using Bosworth screws, suture anchors, hook plates [HPs], or TightRope) [ 3 , 7 – 14 ], AC fixation (using tension band wires, Kirschner wires, or sutures) [ 8 , 15 ], AC or CC reconstruction, and ligament transfer (Weaver–Dunn procedures) [ 16 ], have been investigated [ 17 – 22 ]. However, the optimal treatment for ACJ dislocation is still debated [ 3 , 8 , 23 , 24 ]. The clavicle HP is used in one of the most common techniques to promote CC ligament scaring [ 25 – 27 ].…”

A Modified Endoscopic Technique with Three Incisions for Rockwood Types III and V Acromioclavicular Joint Dislocation

“…In contrast, because of the severity of Rockwood type IV–VI injuries and the large displacement of the acromioclavicular joint, surgery is recommended for these types of acromioclavicular joint dislocation 5 . At present, the surgical methods for the treatment of acromioclavicular joint dislocation mainly include hook plate fixation, coracoclavicular screw fixation, coracoclavicular tendon reconstruction, coracoclavicular ligament reconstruction, and minimally invasive arthroscopic techniques 6 . Although all methods have a high response rate, complications of shoulder pain, acromial impact, weakening of upper limb strength, recurrence of dislocation, distal clavicle, and coracoid process fracture still exist 7,8 .…”

“… 5 At present, the surgical methods for the treatment of acromioclavicular joint dislocation mainly include hook plate fixation, coracoclavicular screw fixation, coracoclavicular tendon reconstruction, coracoclavicular ligament reconstruction, and minimally invasive arthroscopic techniques. 6 Although all methods have a high response rate, complications of shoulder pain, acromial impact, weakening of upper limb strength, recurrence of dislocation, distal clavicle, and coracoid process fracture still exist. 7 , 8 Among these surgical methods, the size and number of surgical incisions may affect the postoperative recovery speed and the esthetic outcome.…”