Recommendations for Optimizing Acromioclavicular Fixation Success with the Tight Rope Device

Abstract

Purpose: To determine if the TightRope device (Arthrex Naples, FL) for fixation of acromioclavicular (AC) separations can create an environment for biologic healing of the coracoclavicular (CC) ligaments.Methods: Twenty-five male subjects, sustained Grade V AC separations. All patients had AC reconstruction with the TightRope device (Arthrex, Naples, FL). The time from the injury to surgical fixation averaged 13 days.Results: Twenty-one of 25 patients had an anatomic reduction of their AC joint. Four were reduced to a near-anatomic (within 2mm) reduction. At final followup, four (16%) patients maintained their anatomic reduction. These four patients underwent surgery at an average of 11 days after the date of injury and had an average age of 25 years. Thirteen (52%) patients displaced to a grade II level (Rockwood classification). These patients averaged 10 days from the date of injury to the date of surgery and had an average age of 39 years. Eight (32%) of the 25 had displaced back to a grade III level (Rockwood classification). These patients averaged 18 days from the date of injury until date of surgery and had an average age of 35 years. All 25 patients described a subjective improvement regardless of displacement. Conclusion:There is a high rate of loss of reduction when using the TightRope (Arthrex, Naples, FL) device. When this device is employed, it should be done as quickly as possible after injury. When the time from injury to surgery exceeds 11 days, loss of reduction seems to be greater. There may be a correlation between older age and a more significant loss of reduction regardless of the acuity of fixation. Level of evidence:IV.