Comparison of Results between Hook Plate Fixation and Ligament Reconstruction for Acute Unstable Acromioclavicular Joint Dislocation

Abstract

BackgroundIn the present study, we aimed to compare clinical and radiographic outcomes between hook plate fixation and coracoclavicular (CC) ligament reconstruction for the treatment of acute unstable acromioclavicular (AC) joint dislocation.MethodsForty-two patients who underwent surgery for an unstable acute dislocation of the AC joint were included. We divided them into two groups according to the treatment modality: internal fixation with a hook plate (group I, 24 cases) or CC ligament reconstruction (group II, 18 cases). We evaluated the clinical outcomes using a visual analog scale (VAS) for pain and Constant-Murley score, and assessed the radiographic outcomes based on the reduction and loss of CC distance on preoperative, postoperative, and final follow-up plain radiographs.ResultsThe mean VAS scores at the final follow-up were 1.6 ± 1.5 and 1.3 ± 1.3 in groups I and II, respectively, which were not significantly different. The mean Constant-Murley scores were 90.2 ± 9.9 and 89.2 ± 3.5 in groups I and II, respectively, which were also not significantly different. The AC joints were well reduced in both groups, whereas CC distance improved from a mean of 215.7% ± 50.9% preoperatively to 106.1% ± 10.2% at the final follow-up in group I, and from 239.9% ± 59.2% preoperatively to 133.6% ± 36.7% at the final follow-up in group II. The improvement in group I was significantly superior to that in group II (p < 0.001). Furthermore, subluxation was not observed in any case in group I, but was noted in six cases (33%) in group II. Erosions of the acromion undersurface were observed in 9 cases in group I.ConclusionsIn cases of acute unstable AC joint dislocation, hook plate fixation and CC ligament reconstruction yield comparable satisfactory clinical outcomes. However, radiographic outcomes based on the maintenance of reduction indicate that hook plate fixation is a better treatment option.

Is Coracoclavicular Reconstruction Necessary in Hook Plate Fixation for Acute Unstable Acromioclavicular Dislocation?

“…Regarding hook plate xation, the hook plays an important role in stabilization in ACJ dislocation, but the focused high pressure over the hook tip may cause erosion of bone cortex ( Figure 5). Among patients with hook plate xation, 25-50% suffer subacromial osteolysis or erosion [10,[19][20][21], which are the most common complications in hook plate xation. Subacromial osteolysis may result in more postoperative pain, discomfort, and an impaired functional outcome [9,10].…”

“…Among patients with hook plate xation, 25-50% suffer subacromial osteolysis or erosion [10,[19][20][21], which are the most common complications in hook plate xation. Subacromial osteolysis may result in more postoperative pain, discomfort, and an impaired functional outcome [9,10]. Yoon et al also reported a trend of an inferior functional score in patients with subacromial osteolysis [10], which indicated that greater stress on the hook tip may lead to a greater risk of subacromial osteolysis.…”

“…In a recent study, hook plate xation was reported to be a popular option that provides rigid xation and promotes nature scaring of the CC ligament, with the advantages of a simpler surgical technique, minimally-invasive access, and early resumption of normal activity [4,[7][8][9]. Despite these advantages, hook plate xation also has disadvantages, which include the need for implant removal surgery, subacromial impingement, subacromial osteolysis, and possible loss of reduction after implant removal, which may lead to complications such as a rotator cuff tear or an acromion fracture in patients with osteoporosis or those with a high activity level [10][11][12].…”

Comparative Outcome of Loop Suspensory Reconstruction and Hook Plate Fixation for Acute Type III-V Acromioclavicular Joint Dislocation

“…xation are common procedures with good clinical outcomes. Although there exists comparative research regarding these two common surgical modalities in terms of postoperative outcome and complications [18,19], the treatment options remain under debate. Thus, the purpose of the present study was to compare these two common procedures with regards to functional outcomes and radiological outcomes in patients with acute advanced AC joint dislocation.…”

Is coracoclavicular reconstruction necessary in hook plate fixation for acute unstable acromioclavicular dislocation?

“…In a recent study, hook plate xation was reported to be a popular option that provides rigid xation and promotes nature scaring of the CC ligament, with the advantages of a simpler surgical technique, minimally-invasive access, and early resumption of normal activity [4,[10][11][12]. Despite these advantages, hook plate xation alsohas disadvantages, which include the need for implant removal surgery, subacromial impingement, subacromial osteolysis, and possible loss of reduction after implant removal, which may lead to complications such as a rotator cuff tear or an acromion fracture in patients with osteoporosis or those with a high activity level [13][14][15].…”