Controversies relating to the management of acromioclavicular joint dislocations

Abstract

The aim of this review is to address controversies in the management of dislocations of the acromioclavicular joint. Current evidence suggests that operative rather than non-operative treatment of Rockwood grade III dislocations results in better cosmetic and radiological results, similar functional outcomes and longer time off work. Early surgery results in better functional and radiological outcomes with a reduced risk of infection and loss of reduction compared with delayed surgery. Surgical options include acromioclavicular fixation, coracoclavicular fixation and coracoclavicular ligament reconstruction. Although non-controlled studies report promising results for arthroscopic coracoclavicular fixation, there are no comparative studies with open techniques to draw conclusions about the best surgical approach. Non-rigid coracoclavicular fixation with tendon graft or synthetic materials, or rigid acromioclavicular fixation with a hook plate, is preferable to fixation with coracoclavicular screws owing to significant risks of loosening and breakage. The evidence, although limited, also suggests that anatomical ligament reconstruction with autograft or certain synthetic grafts may have better outcomes than non-anatomical transfer of the coracoacromial ligament. It has been suggested that this is due to better restoration horizontal and vertical stability of the joint. Despite the large number of recently published studies, there remains a lack of high-quality evidence, making it difficult to draw firm conclusions regarding these controversial issues.

Clinical and Radiologic Outcomes of Acute Acromioclavicular Joint Dislocation: Comparison of Kirschner's Wire Transfixation and Locking Hook Plate Fixation

“…Consequently, hook plate seems to be capable of anatomical reduction in superoinferior reduction even without coracoclavicular ligament reconstruction. Modi et al 10) reported that the goal of fixation of ACJ is to restore the CCD in order to allow healing of the ruptured ligaments. Also, Luis et al 26) reported that coracoclavicular ligament repair is unnecessary with hook plates because anatomical reduction is done.…”

“…9) Its use has increased since the advent of locking plate with locking screws and good results are being reported. 10,11) But there are few reports comparing the clinical outcomes of these two techniques, and there is no report comparing two techniques in Korea. The purpose of this study is to use K-wire transfixation and locking hook plate fixation technique for ACJ stabilization in acute ACJ dislocation patients and retrospectively compare the clinical and radiologic outcomes.…”

Clinical and Radiological Outcomes of Acute Acromioclavicular Joint Dislocation: Comparison of Hook Plate Fixation with Single Tight Rope Technique

“…19,20) However, there are known disadvantages associated with this technique, including a mandatory second surgery for removal of the plate. Moreover, transarticular fixation using an HP may induce bony osteolysis, shoulder impingement, and rotator cuff damage, leading to poor functional results.…”

Arthroscopic Anatomic Coracoclavicular Ligament Repair Using a 6-Strand Polyester Suture Tape and Cortical Button Construct

“…1 In addition, all of these implants require removal. The more recent trend toward tunnel and suture-graft fixation appears promising, but direct comparison of different techniques is difficult because multiple variables exist, including the use of 1 versus 2 tunnels, graft versus suture, allograft versus autograft, and adjustable-length suture versus nonadjustable suture.…”

“…Management of grade III separations remains controversial. 1 Multiple operative techniques for these injuries have been described. More historical methods of fixation include Kirschner wires, hook plates, and use of a coracoclavicular screw.…”