Comparison of Effectiveness and Safety in Treating Acute Acromioclavicular Joint Dislocation with Five Different Surgical Procedures: A Systematic Review and Network Meta‐Analysis

Abstract

This network meta‐analysis aims to evaluate the comparative effectiveness and safety of suture anchors (SA), tendon grafts (TG), hook plates (HP), Tight‐Rope (TR), and EndoButton (EB) in the treatment of acute acromioclavicular joint (ACJ) dislocation. The Embase, PubMed, and Web of Science databases were searched from their inception date to June 3, 2022. Studies included all eligible randomized controlled trials (RCTs) and cohort studies with the comparison of five different fixation systems among SA, TG, HP, TR, and EB were identified. All studies were reviewed, performed data extraction, and assessed the risk of bias independently by two reviewers. The primary outcomes are Constant–Murley score (CMS) improvement for assessing clinical efficacy, and complications. The second outcomes are visual analog scale (VAS) for assessing pain relief and the coracoclavicular distance (CCD) for assessing postoperative joint reduction. Version 2 of the revised Cochrane risk of bias tool for randomized trials (RoB 2) and the risk of bias in nonrandomized studies of interventions (ROBINS‐I) were used to assess the RCTs and non‐randomized trials, respectively. The continuous outcomes were presented as mean differences (MD), and risk ratios (OR) were used for dichotomous outcomes, both with 95% confidence intervals (CI). Surface under the cumulative ranking curves (SUCRA) results were calculated to offer a ranking of each intervention. We identified 31 eligible trials, including 1687 patients in total. HP showed less CMS improvement than TR and EB in both the Network Meta‐analysis (NMA) and pairwise meta‐analysis. HP also showed less CMS improvement than SA in NMA. For pain relief, HP performed worse than TR both in pairwise meta‐analysis and NMA. No significant differences were found for the measured value of CCD. Both TR and EB showed a lower incidence of complications than HP in pairwise meta‐analysis. The rank of SUCRA for CMS improvement was as follows: SA, TR, EB, TG, and HP; for pain relief: TR, EB, TG, SA, and HP; for CCD: HP, TR, SA, EB, and TG. For complications, HP showed the highest rank, followed by TG, EB, TR, and SA. SA shows better clinical effectiveness and reliable safety in the treatment of acute ACJ dislocation. Although HP is the most widely used surgical option currently, it should be carefully taken into consideration for its high incidence of complications.

Revisión de las opciones terapéuticas aplicadas actualmente para la luxación acromioclavicular aguda y crónica

“…Radiológicamente se observó complicaciones como: desplazamiento de los alambres kirschner y en algunos casos pérdida de la reducción. (Yan et al, 2023) Técnica de gancho -placa Fosser & Camporese, (2021), los resultados ofrecidos por esta técnica son bastantes buenos, puesto que los pacientes refieren tener un rango de movilidad amplio con ausencia de dolor y bloqueos mecánicos; regresaron a sus actividades cotidianas en muy poco tiempo, pero algo importante que destacar es que siempre está presente la sensación del lado operado en relación con la parte contralateral, incluso no se puede dormir a ese lado y en algunos casos presentaron parestesias y ninguno presentó recurrencia o pérdida de la reducción, según las radiografías de seguimiento. Resulta que según Franovic et al, (2021) es la técnica más costosa con relación a las demás ya que ocupa más tiempo para la recuperación.…”

“…Lee et al, (2019), el tratamiento va enfocado según el grado de lesión en dependencia de la deformidad y el porcentaje de desplazamiento de aquellas estructuras que conforman la articulación. Además, todo proceso quirúrgico trae consigo riesgo de complicaciones, por lo que se considera como una importante desventaja según Yan et al, (2023). cubrir con el tirante del sujetador y casi no se forman queloides convirtiéndola en una de las mejores técnicas.…”

The Effect of Clavicular Tunnel Position on Reduction Loss in Patients with Acute Acromioclavicular Joint Dislocations Operated with a Single‐Bundle Suspensory Loop Device

“…However, each treatment option has its own set of advantages and disadvantages, and there is no consensus on the superiority of one treatment over another. 7 Some implant types used in treatment act as temporary support by maintaining ACJ reduction until ligament healing is completed. Recently, satisfactory clinical outcome and pain relief have been reported with the suspensory loop device (SLD), which can be performed open and arthroscopically for this purpose.…”

Shoulder and Elbow Surgery Special Issue

“…This issue features 32 professional articles, including three review articles, 21 clinical articles, four research articles, two operative techniques, and two case reports, contributed by well-known orthopaedic experts from China, the United States, Korea, and Europe.The elbow section of this issue includes papers on arthroscopy, 1 open surgery in elbow stiffness, 2,3 fractures, 4 total elbow arthroplasty, 5 and conservative methods of treatment. 6 The shoulder section addresses a multitude of anatomic details as well as techniques, including clavicular shaft and distal fractures, acromioclavicular joint traumatic and degenerative conditions, [7][8][9][10][11] rotator cuff pathologies and fixation techniques, treatment of the post-surgical or post-traumatic glenohumeral stiffness, fractures of the proximal humerus, 5,[12][13][14][15][16][17][18][19][20][21] the safety of irrigation in the shoulder arthroscopy, management of the scapular and glenoid fractures, radiologic and 3D models. [22][23][24][25][26][27][28][29][30][31] Overall, this special issue contains plenty of meaningful readings for surgeons specializing in shoulder and elbow surgery and for general orthopaedic and trauma specialists, as well as for orthopaedic residents and young surgeons worldwide.…”

“…The elbow section of this issue includes papers on arthroscopy , 1 open surgery in elbow stiffness 2 , 3 fractures , 4 total elbow arthroplasty , 5 and conservative methods of treatment. 6 The shoulder section addresses a multitude of anatomic details as well as techniques, including clavicular shaft and distal fractures, acromioclavicular joint traumatic and degenerative conditions, 7 , 8 , 9 , 10 , 11 rotator cuff pathologies and fixation techniques, treatment of the post‐surgical or post‐traumatic glenohumeral stiffness, fractures of the proximal humerus, 5 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 the safety of irrigation in the shoulder arthroscopy, management of the scapular and glenoid fractures, radiologic and 3D models. 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 …”