Has the arthroscopically assisted reduction of acute AC joint separations with the double tight-rope technique advantages over the clavicular hook plate fixation?

Gunnar Jensen, Jan Christoph Katthagen, Laura Esther Alvarado, Helmut Lill, Christine Voigt
Knee Surgery, Sports Traumatology, Arthroscopy 2014, 22 (2): 422-30

PURPOSE: The purpose of this study was to compare the results after arthroscopically assisted double TightRope(®)-(TR) reduction with results after clavicular hook plate (HP) fixation in acute high-grade acromioclavicular (AC) joint separations.

METHODS: Between 2004 and 2010, 69 consecutive patients with acute AC joint separations type Rockwood III and V were subjected to surgical reconstruction. 56 patients (81 %) were available for evaluation. Thereof, 30 (median age: 39 years; n = 12 acute Rockwood III and n = 18 Rockwood V injuries) were treated by a clavicular HP and 26 (median age: 39 years; n = 10 acute Rockwood III and n = 16 Rockwood V injuries) using the double TR technique. Group HP was evaluated at a median of 48 (7-77) months after surgery and the TR group 17 (7-29) months after stabilization. Visual Analogue Scale (VAS) for Pain, Simple Shoulder Test (SST), Constant Score (CS) and Taft Score (TS) were assessed. Sonographic measurements were performed to evaluate recurrent instability.

RESULTS: Clinical examination demonstrated comparable results without significant differences. In the groups HP and TR, the VAS was median 0.8 (range, 0.0-7.5) and 0.4 (range, 0.0-5.7), the SST reached median 11 (range, 0-12 points) and 12 points (range, 8-12 points). The CS was median 92.4 % (range, 21.5-105.4 %) and 94.0 % (range, 54.6-105.3 %) and the TS median 10 (range, 3-12 points) and 10 points (range, 5-12 points). Sonographic measurements showed a mean coracoclavicular (CC) distance of 25.3 ± 4.5 (HP) and 25.5 ± 4.3 mm (TR) (n.s.). In both groups, CC distance of the operated side was significantly higher compared to the uninjured side. The complication rate was 13 % in group HP and 12 % in group TR.

CONCLUSIONS: In acute high-grade AC joint instabilities, both techniques lead to mostly good and excellent clinical results, although comparable partial recurrent vertical instability could be observed. Diagnosis and therapy of concomitant glenohumeral injuries and no obligatory implant removal are advantages of the arthroscopic procedure.

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