Current Concepts in the Operative Management of Acromioclavicular Dislocations: A Systematic Review and Meta-analysis of Operative Techniques

Abstract

Background: Acromioclavicular (AC) instability is a frequent injury affecting young and athletic populations. Symptomatic, high-grade dislocations may be managed by a myriad of operative techniques that utilize different grafts to achieve reduction. Comparative data are lacking on the ability of these techniques to achieve excellent patient outcomes and stable AC reduction and to minimize complications. Purpose: To systematically review the outcomes and complications of different techniques of AC joint reconstruction. Study Design: Systematic review and meta-analysis. Methods: The MEDLINE, Scopus, Embase, and Cochrane Library databases were accessed to perform a systematic review of the scientific literature from 2000 to 2018 using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) criteria with the following keywords: “acromioclavicular” and “reconstruction.” Included articles were evaluated for loss of reduction, complication rate, revision rate, and change in coracoclavicular distance. Articles were stratified by graft and surgical material used: suture only, Endobutton with suture, TightRope, GraftRope, synthetic artificial ligament, tendon graft, and Weaver-Dunn coracoacromial ligament transfer. These outcomes were pooled using a random-effects model and stratified by surgical technique and arthroscopic versus open reconstruction. Results: Fifty-eight articles were included in the analysis, with 63 homogeneous populations composed of 1704 patients. The mean age was 37.1 years (range, 15-80 years) with a mean follow-up of 34.3 months (range, 1.5-186 months). The overall failure rate was 20.8% (95% CI, 16.9%-25.2%). The overall pooled complication rate was 14.2% (95% CI, 10.5%-18.8%). The most common complications were infection (6.3% [95% CI, 4.7%-8.2%]), fracture to the coracoid or distal clavicle (5.7% [95% CI, 4.3%-7.6%]), and hardware/button failure (4.2% [95% CI, 3.1%-5.8%]). There were no differences between arthroscopic and open techniques in regard to loss of reduction ( P = .858), overall complication rate ( P = .774), and revision rate ( P = .390). Open surgery had a greater rate of clavicular/coracoid fractures than arthroscopic surgery ( P = .048). Heterogeneity, best assessed from the pooled loss of reduction, was measured as I2 = 64.0%. Conclusion: Open and arthroscopic AC joint reconstruction techniques have no differences in loss of reduction, the complication rate, and the revision rate based on the available literature. Complications are significant, and profiles vary between surgical techniques, which should be evaluated in the decision making of selecting the technique.

TightRope vs Clavicular Hook Plate for Rockwood III–V Acromioclavicular Dislocations: A Meta‐Analysis

“…Their results demonstrated that there were no significant differences between arthroscopic and open techniques in terms of loss of reduction (P = 0.858), overall complication rate (P = 0.774), and revision rate (P = 0.390) 46 . Moreover, open surgery was associated with a higher rate of clavicular/coracoid fractures than arthroscopic surgery (P = 0.048) 46 . The authors concluded that open and arthroscopic techniques showed similar effect and complication in the reconstruction of ACJ.…”

“…To the best of our knowledge, the present study is the first meta-analysis that compares the functional, radiological, and complication outcomes of TightRope ® fixation with that of hook plate fixation in patients with Rockwood III-VI ACJ dislocations. Reviewing the literature, there were several systematic review and meta-analysis that had been published to assess the effect and safety of different surgical techniques for acute ACJ dislocation [45][46][47] . Arirachakaran et al 45 performed a systematic review and meta-analysis to compare the postoperative outcomes and complications of hook plate vs suspensory loop fixation (LSF) in acute unstable ACJ.…”

“…In another meta-analysis, Gowd et al 46 reviewed 58 articles with 1704 patients to compare the outcomes and complications of different techniques of ACJ reconstruction. Their results demonstrated that there were no significant differences between arthroscopic and open techniques in terms of loss of reduction (P = 0.858), overall complication rate (P = 0.774), and revision rate (P = 0.390) 46 . Moreover, open surgery was associated with a higher rate of clavicular/coracoid fractures than arthroscopic surgery (P = 0.048) 46 .…”

Anatomical parameters of the coracoclavicular ligament: A study of 480 cases

“…In 1972, the Weaver-Dunn procedure was first described, which utilized the native AC ligament in AC joint reconstruction (15). Following this kind of technique was improved on, the utilization of autograft or allograft for the anatomic reconstruction of CC ligament in AC joint dislocation has rapidly gained popularity in the past few decades (9). The reconstructions using either tendon grafts or suture-button configurations in anatomically placed drill holes have been demonstrated to biomechanically replicate the intact CC ligament complex and improved clinical effects as well.…”

“…So that in accordance with different types, the treatment for AC joint dislocation have not been uniform and the results also vary. Most AC joint dislocations can be treated nonoperatively, symptomatic and high-grade dislocations like type III to VI 3 may be managed by a myriad of surgical techniques (2,9). Overall, more than 60 surgical techniques have been described so far (19), but the optimal one still remains controversial (4, 22).…”