[Comparative study on the treatment of acromioclavicular joint dislocation: coracoclavicular ligament reconstruction combined with hook plate fixation or suture-anchor fixation]

Wei-jun An, Jian-bin Sun, Peng Ye, Wei-wei Guo
Zhonghua Wai Ke za Zhi [Chinese Journal of Surgery] 2013, 51 (4): 349-53

OBJECTIVE: To investigate the clinical outcomes of acromioclavicula (AC) joint dislocation treated with coracoclavicular (CC) ligament reconstruction and hook plate fixation/suture-anchor fixation.

METHODS: There were 105 patients with Rockwood type III or severer AC joint dislocations were randomly divided into two groups from February 2007 to April 2010. They were treated with CC ligament reconstruction using double bundle of Palmaris longus (hook plate fixation group, 54 cases), and subsequently fixed with hook plates or suture-anchors (suture-anchors group, 51 cases). Patients were followed up, and the AC distance and CC distance were measured on the postoperative X-ray films, and the outcomes were assessed according to Karlsson criteria and Constant-Murley shoulder score. Ranked data was analyzed with the use of χ(2) test and measurement data with two sample t test.

RESULTS: Eighty-nine patients were followed up for 24-42 months, average 30 months. There were 46 cases in hook plate fixation group and 43 cases in suture-anchor fixation group, without significant difference in age, gender, injured side and Rockwood classification between both groups. Between the two groups, no statistical difference was detected in the AC and CC distance measured within 6 months after operation (P > 0.05). The AC and CC distances of hook plate fixation group measured in 24 months postoperatively were larger than those in suture-anchor fixation group, respectively (F = 1.904 and 1.854, P < 0.05). In hook plate fixation group, the AC and CC distances measured in 24 months postoperatively were larger than those measured in 6 month postoperatively, respectively (F = 1.863 and 1.842, P < 0.05). According to Constant-Murley shoulder score, the average score was 88.5 for hook plate fixation group and 92.7 for suture-anchor fixation group (F = 0.475, P = 0.017). According to Karlsson criteria, the excellent and good rate of the functional recovery was 95.4% in suture-anchor fixation group, better than hook plate fixation group (χ(2) = 4.564, P = 0.033).

CONCLUSIONS: The clinical outcomes of AC joint dislocation treated with CC ligament reconstruction and suture-anchor fixation are better than those treated with CC ligament reconstruction and hook plate fixation. The AC and CC distances increase after the removal of hook plate, which may be associated with poor functional recovery.

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