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

Abstract

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.

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

“…In this study, group II demonstrated a signi cantly shorter surgical duration and less blood loss as compared with group I (101.0 ± 38.0 vs 66.6 ± 26.1 minutes, p = 0.005; 17.5 ± 25.6 vs 43.8 ± 45.6 ml, p = 0.015). The result was compatible with a systemic review and meta-analysis by Alisara et al [25], which indicated that hook plate xation required a signi cantly shorter surgical duration than loop suspensory…”

Surgical treatment of acute Rockwood III acromioclavicular dislocations—Comparative study between two flip-button techniques

“…Many surgical methods have been developed over decades and there still exists a problem concerning the optimal operative treatment between internal fixation or reconstruction of CC ligaments, both of which have their pros and cons 6 . For CC ligaments reconstruction, non-absorbable suture, allogenous/autogenous tendons and the flip-button techniques such as Tightrope system (Arthrex Inc, Naples, FL, USA) and Endobutton system (Smith&Nephew Inc, Memphis, TN, USA) have been widely used [7][8][9][10][11] .…”

The experience of minimally invasive restoration of acromioclavicular joint anatomy from mini-approach

“…Оценивая биомеханические свойства приме-няемых фиксаторов, коллектив ортопедов из Гер-мании провёл исследование в лабораторных усло-виях особенностей нативного АКС по сравнению с АКС после хирургического восстановления тремя разными методами фиксации: крючковидной плас-тиной, «TightRope» и якорным фиксатором [13]. Для того чтобы выяснить, какой имплантат имитирует физиологические свойства сустава лучше всего, была оценена осевая жёсткость при вертикальной стабильности в сочетании с ротацией.…”

“…После изучения «биомеханического анализа трёх способов стабилизации АКС», проведённо-го коллективом авторов из Германии [13], воз-никла другая гипотеза, согласно которой нельзя исключить недостаточность фиксации одной системой (две пуговицы и одна нить), предот-вращающей смещение (вывих) только в одной плоскости. Возможно, что при использовании систем типа «Double TightRope», где фиксацию выполняют тремя пуговицами и двумя нитями, проводимыми через три костных «точки», дан-ного осложнения можно было бы избежать.…”