Document Type: RESEARCH PAPER

Authors

1 Department of Orthopedics, Imam Khomeini Hospital, Urmia University of Medical Sciences, Urmia, Iran

2 Clinical Research Development Unit of Imam Khomeini Hospital, Urmia University of Medical Sciences, Urmia, Iran Department of Orthopedics, Imam Khomeini Hospital, Urmia University of Medical Sciences, Urmia, Iran

Abstract

Background: This study was conducted to evaluate the clinical outcomes of the acromioclavicular joint (ACJ)
fixation with hook plate (HP) and continuous loop double endobutton fixation (CLDE) in the treatment of acute ACJ
dislocation.
Methods: This retrospective study was conducted on eight patients with HP and nine patients with CLDE fixations for
acute ACJ dislocations. The subjects were evaluated by various criteria, including disabilities of the Arm, Shoulder,
and Hand (DASH), American Shoulder and Elbow Surgeons Standardized Shoulder Assessment (ASES), University
of California, Los Angeles (UCLA) shoulder rating scale, Shoulder Constant score, Simple Shoulder Test (SST), and
coracoclavicular (CC) distance.
Results: The differences between the mean scores of the visual analog scale for pain, DASH, ASES, UCLA
shoulder rating scale, and Shoulder Constant, and SST were statistically significant in favor of the CLDE group.
Mean difference of CC distance was 8.6±0.9 mm in the HP group; however, it was 11.6±1.2 mm in the CLDE group.
The operation time was shorter in the HP fixation, compared to that in the CLDE fixation (51±13.3 versus 105±9.7
min; PHP group.
Conclusion: The CLDE fixation was reported with better clinical outcomes than HP fixation; however, it was a technically
demanding procedure. The HP maintained the CC distance better than CLDE with a technically easy application. The
HP requires a second surgery for the removal and development of subacromial erosion and osteoarthritis of the ACJ
that can be regarded as major concerns.
Level of evidence: III

Keywords

Main Subjects

1. Teodoro RL, Nishimi AY, Pascarelli L, Bongiovanni
RR, Velasco MA, Dobashi ET. Surgical treatment of
acromioclavicular dislocation using the endobutton.
Acta Ortop Bras. 2017; 25(3):81-4.
2. Domos P, Sim F, Dunne M, White A. Current
practice in the management of Rockwood type
III acromioclavicular joint dislocations-National
survey. J Orthop Surg (Hong Kong). 2017; 25(2):
2309499017717868.
3. Rockwood CA Jr. Injuries to the acromioclavicular
joint. In: Rockwood CA Jr, Williams GR, Young DC,
editors. Rockwood & Green’s fractures in adults. 4th
ed. Philadelphia: Lippincott-Raven Publishers; 1996.
4. Struhl S, Wolfson TS. Continuous loop double
endobutton reconstruction for acromioclavicular
joint dislocation. Am J Sports Med. 2015; 43(10):
2437-44.
5. Struhl S. Double endobutton technique for repair
of complete acromioclavicular joint dislocations.
Techniq Shoulder Elbow Surg. 2007; 8(4):175-9.
6. Murena L, Vulcano E, Ratti C, Cecconello L, Rolla
PR, Surace MF. Arthroscopic treatment of acute
acromioclavicular joint dislocation with double flip
button. Knee Surg Sports Traumatol Arthrosc. 2009;
17(12):1511-5.
7. Natera-Cisneros L, Sarasquete-Reiriz J, Escolà-
Benet A, Rodriguez-Miralles J. Acute high-grade
acromioclavicular joint injuries treatment: arthroscopic
non-rigid coracoclavicular fixation provides better
quality of life outcomes than hook plate ORIF. Orthop
Traumatol Surg Res. 2016; 102(1):31-9.
8. Arirachakaran A, Boonard M, Piyapittayanun P,
Kanchanatawan W, Chaijenkij K, Prommahachai A,
et al. Post-operative outcomes and complications of
suspensory loop fixation device versus hook plate in
acute unstable acromioclavicular joint dislocation:
a systematic review and meta-analysis. J Orthop
Traumatol. 2017; 18(4):293-304.
9. Athar MS, Ashwood N, Arealis G, Hamlet M, Salt E.
Acromioclavicular joint disruptions: A comparison
of two surgical approaches ‘hook’ and ‘rope’. J Orthop
Surg (Hong Kong). 2018; 26(1):2309499017749984.
10. Bin Abd Razak HR, Yeo EN, Yeo W, Lie TD. Short-term
outcomes of arthroscopic TightRope® fixation are
better than hook plate fixation in acute unstable
acromioclavicular joint dislocations. Eur J Orthop
Surg Traumatol. 2017; 28(5):869-75.
11. Cai L, Wang T, Lu D, Hu W, Hong J, Chen H. Comparison
of the tight rope technique and clavicular hook
plate for the treatment of Rockwood type III
acromioclavicular Joint Dislocation. J Invest Surg.2017; 31(3):226-33.

12. Chen CH, Dong QR, Zhou RK, Zhen HQ, Jiao YJ. Effects
of hook plate on shoulder function after treatment
of acromioclavicular joint dislocation. Int J Clin Exp
Med. 2014; 7(9):2564-70.
13. De Baets T, Truijen J, Driesen R, Pittevils T. The
treatment of acromioclavicular joint dislocation
Tossy grade III with a clavicle hook plate. Acta
Orthop Belg. 2004; 70(6):515-9.
14. Ding M, Ni J, Hu J, Song D. Rare complication of
clavicular hook plate: clavicle fracture at the medial
end of the plate. J Shoulder Elbow Surg. 2011;
20(7):18-20.
15. Eschler A, Gradl G, Gierer P, Mittlmeier T, Beck M.
Results after AC joint repair with the hook plate.
Arch Orthop Trauma Surg. 2012; 132(1):33-9.
16. Gao YS, Zhang YL, Ai ZS, Sun YQ, Zhang CQ, Zhang
W. Transarticular fixation by hook plate versus
coracoclavicular stabilization by single multistrand
titanium cable for acute Rockwood grade-V
acromioclavicular joint dislocation: a case-control
study. BMC Musculoskelet Disord. 2015; 16(1):360.
17. Lu D, Wang T, Chen H, Sun LJ. A comparison of double
Endobutton and triple Endobutton techniques for
acute acromioclavicular joint dislocation. Orthop
Traumatol Surg Res. 2016; 102(7):891-5.
18. Lim YW. Triple endobutton technique in
acromioclavicular joint reduction and reconstruction.
Ann Acad Med Singapore. 2008; 37(4):294-9.
19. Metzlaff S, Rosslenbroich S, Forkel PH, Schliemann
B, Arshad H, Raschke M, et al. Surgical treatment of
acute acromioclavicular joint dislocations: hook plate
versus minimally invasive reconstruction. Knee Surg
Sports Traumatol Arthrosc. 2016; 24(6):1972-8.
20. Wei HF, Chen YF, Zeng BF, Zhang CQ, Chai YM, Wang
HM, et al. Triple endobuttton technique for the
treatment of acute complete acromioclavicular joint
dislocations: preliminary results. Int Orthop. 2011;
35(4):555-9.
21. Yoon JP, Lee BJ, Nam SJ, Chung SW, Jeong WJ, Min
WK, et al. Comparison of results between hook
plate fixation and ligament reconstruction for acute
unstable acromioclavicular joint dislocation. Clin
Orthop Surg. 2015; 7(1):97-103.
22. Zhang L, Zhou X, Qi J, Zeng Y, Zhang S, Liu G, et al.
Modified closed-loop double-endobutton technique
for repair of Rockwood type III acromioclavicular
dislocation. Exp Ther Med. 2018; 15(1):940-8.
23. Zhang J, Ying Z, Wang Y. surgery for acromioclavicular
dislocation: factors affecting functional recovery. Am
Surg. 2017; 83(12):1427-32.