Effect of subacromial erosion shape on rotator cuff and clinical outcomes after hook plate fixation in type 5 acromioclavicular joint dislocations: a retrospective cohort study

Abstract

Background Surgical fixation using hook plates is widely used in the treatment of acromioclavicular (AC) joint dislocations. The purpose of this study was to evaluate the incidence and shape of subacromial erosions after removal of the hook plate in type 5 AC joint dislocations. Further, we evaluated the effect of the shape of the subacromial erosion on the rotator cuff. Methods We retrospectively reviewed 30 patients who underwent hook plate fixation for type 5 AC joint dislocations at our hospital between December 2010 and December 2018. Patients with a follow-up of at least 1 year were included. Clinical outcomes were assessed using the final follow-up Constant-Murley, Korean Shoulder, and visual analog scores. To ensure that the appropriate reduction was well maintained, the coracoclavicular distances of the injured and contralateral sides were evaluated at the last follow-up. Computed tomography was performed to investigate the presence and shape of the subacromial erosion after hook plate removal at 4 months after surgery. Ultrasonography was performed to investigate the presence of rotator cuff lesions at the last follow-up. Clinical and radiological outcomes were compared between groups divided according to the presence and types of subacromial erosions. Results Subacromial erosion was observed in 60% of patients (18/30): 13, 2, and 3 simple groove, cave, and marginal protrusion types, respectively. Four patients showed reduction loss at the final follow-up. There were no significant differences in clinical and radiological outcomes between the groups with and without subacromial erosion. Moreover, there were no significant differences between groups according to the types of subacromial erosion. There were no rotator cuff lesions, such as partial tears, in the injured shoulders. Conclusions Hook plate fixation may induce subacromial erosions. However, the subacromial erosions caused by the hook plate did not affect the clinical outcomes of type 5 AC joint dislocations. Moreover, regardless of its shape, the subacromial erosion did not affect the clinical outcomes nor cause rotator cuff lesions after plate removal.

Treatment of acromioclavicular dislocations with a concomitant coracoid fracture: a systematic review of 37 patients

“…One might argue that surgical procedures have changed throughout the years and may result in different outcomes. Recent articles on sole AC dislocations still show good anatomical and functional results after treatment with a hook plate, 32,39 while new anatomical reconstruction techniques are gaining popularity and show promising results. 13,15,23 Nonetheless, we decided to include older articles as well to provide a complete summary of the current available literature since the available data on this combined injury are limited.…”

Stressed and Deformed State of the Acromioclavicular Joint in Case of Damage to the Inferior Acromioclavicular Ligament and Various Methods of Fixation

“…Конкуруючими металевими конструкціями для забезпечення фіксації є гачкоподібна пластинаhook platе, запропонована Fade G. E., Scullion J. E. (2002) [2] та спосіб Вебера (tension band wiring) [3].…”

“…Competing metal structures to provide fixation are the hook plate, proposed by Fade G. E., Scullion J. E. (2002) [2] and the Weber method (tension band wiring) [3].…”

The method for fixation of dislocations of the acromial end of the clavicle according to Weber: disadvantages and their factors

“…Кожен спосіб застосування металевих конструкцій має свої переваги та недоліки. Серед недоліків вико-Оригінальні дослідження / Original Researches ристання hook platе: біль у плечі, посттравматичний артрит, спричинений фрагментованими тканинами (як-от фрагментовані кістки, суглобові диски, хрящі та зв'язки), руйнація тканин, яка продовжується у період наявності конструкції, та подразнення периферичних нервів у м'яких тканинах між гачком пластини й акроміоном, синдром субакроміального удару, що призводить до пошкодження обертальної манжети, руйнація кісткової тканини, особливо в ділянці акроміального відростка лопатки з утворенням субакроміальних ерозій [5][6][7][8][9].…”