Surgical treatments for acute unstable acromioclavicular joint dislocations

Open Access

Table 1

Studies included.

Study	Surgical technique	Number of patients	Mean age (years)	Mean follow-up	Post-operative assessment scores	Evaluation of CC distance	Study Design/Level of Evidence	Complications
Hou et al. [40]	Allogenous semitendinosus graft/single tunnel	11	37	16 months	Percentage of good to excellent outcomes: 18%	Not reported	Retrospective study/III	Coracoid fracture: 1 case
Hou et al. [40]	Allogenous semitendinosus graft/two tunnel	10	42	16 months	Percentage of good to excellent outcomes: 70%	Not reported	Retrospective study/III	Wound infection: 2 cases
Kumar et al. [34]	Modified Weaver-Dunn procedure	31	42	40 months	Mean OSS pre op: 28 ± 11	Not reported	Case series/IV	Failure: 3 cases
	Modified Weaver-Dunn procedure	31			OSS post op: 42 ± 10			Superficial wound infection: 3 cases
	Surgilig technique	24			Mean OSS pre op: 26 ± 9			Implant failure: 1 case
	Surgilig technique	24			OSS post op: 45 ± 7			Superficial wound infection: 4 cases
Yoon et al. [22]	Hook plate	24	38.8 ± 14.2	16 ± 12.8 months	VAS: 1.6 ± 1.5	Pre op: 215.7 ± 50.9%	Case series/IV	No cases of AC joint subluxation
	Hook plate	24	38.8 ± 14.2	16 ± 12.8 months	CS: 90.2 ± 9.9	Post op: 106.1 ± 10.2%		Acromion erosion: 9 cases
	CC ligament reconstruction/synthetic ligament	18	42.2 ± 12.3	17.4 ± 4.3 months	VAS: 1.3 ± 1.3	Pre op: 239.9 ± 59.2%		AC joint subluxation: 6 cases
	CC ligament reconstruction/synthetic ligament	18	42.2 ± 12.3	17.4 ± 4.3 months	CS: 89.2 ± 3.5	Post op: 133.6 ± 36.7%		AC joint subluxation: 6 cases
Li et al. [19]	Arthroscopic CC reconstruction/synthetic ligament	32	40.3	29.6 ± 6 months	ASES: 96 ± 5.1	Loss of reduction: 1/32 cases	Retrospective Comparative study/III	Weaver Dunn group: higher rate of loss of reduction
	Arthroscopic CC reconstruction/synthetic ligament	32			UCLA: 34.2 ± 1.5	Loss of reduction: 1/32 cases
	Open modified Weaver Dunn	31			ASES: 94.5	Loss of reduction: 7/31 cases
	Open modified Weaver Dunn	31			UCLA: 33.7 ± 1.4	Loss of reduction: 7/31 cases
Tang et al. [39]	Double Endobutton	31	No significant difference in age between the two groups	11–35 months	CMS: no significant difference between groups (P > 0.05)	Not reported	Case series/IV	Loss of CC reduction: 1 case
Tang et al. [39]	Suture anchor + Endobutton plate	25	No significant difference in age between the two groups	11–35 months	Karlsson grading no significant difference between 2 groups (Z = −0.628, P = 0.530)	Not reported	Case series/IV	Ectopic ossification: 6 cases(both techniques)
Barth et al. [41]	Double endobutton arthroscopic technique in 93% of cases.	116	37	12 months	CMS: >85/100	Pre op: 214%(vertical)	Non-randomized comparative study/II	Early loosening: 3 cases
	Double endobutton arthroscopic technique in 93% of cases.				QuickDASH functional disability <10 in 75% of patients	Pre op: 4 mm (horizontal)		Surgical infection: 2 cases
	Additional acromioclavicular stabilization of the AC joint in 50% of cases.					Post op: 128% (vertical)		Reflex sympathetic dystrophy: 7 patients
						Post op: 0 mm (horizontal)		Distal clavicle osteolysis: 1 case
								Device impingement:5 cases
								Coracoid fracture: 1 case
Cisneros et al. [18]	Arthroscopic CC fixation/synthetic ligament	20	36	>24 months	Global satisfaction: 8.85 ± 0. 93	Not reported	Retrospective Comparative/III	Implant failure: 1 case
					VAS score: 0.40 ± 0.50			Surgical wound granulomas; 2 cases
								Scapular dyskinisis: in 15%
	Hook plate	11	41		Global satisfaction: 8.00 ± 1.18, P = 0.035			Surgical site infection: 1 case
					VAS score 1.45 ± 1.51, P = 0.007			Inability of metalwork removal: 1 case
								Scapular dyskinesis: in 18.18%
Vrgoc et al. [12]	Open Reduction + K-wires + Fiber-Tape	10	41.6	At least 12 months	No significant statistical difference between techniques	Not reported	Case series/IV	Not specifically reported
Vrgoc et al. [12]	Arthroscopic fixation/Tight-Rope	6	37.8	At least 12 months	No significant statistical difference between techniques	Not reported	Case series/IV	Not specifically reported
Yin F et al. [36]	Autologous plantaris graft +hook plate	15	No difference between age groups	21.4 months	CMS: no difference between techniques	CC distance: similar results between the two techniques	Case series/IV	Not specifically reported
	Allogenic tendon + hook plate	16			VAS: no difference between techniques
	Allogenic tendon + hook plate				ROM: no difference between techniques
Faggiani et al. [20]	Mini open AC repair/MINAR system	8	36.94	13 months	CMS: 89.61	Not reported	Retrospective cohort study/II	Not specifically reported
					OMS: 46.13
					SST: 11.38
	Dog Bone arthroscopic technique	8			CMS: 92.6
					OMS: 46.25
					SST: 11.75
Metzlaff et al. [24]	Mini open AC repair (MINAR)/synthetic ligament	44	36.2	32 months	CMS: no difference between techniques	Not reported	Retrospective Comparative/III	Periarticular ossification: 11 cases
	Mini open AC repair (MINAR)/synthetic ligament	44			Taft:no difference between techniques			Periarticular ossification: 8 cases
	Hook plate	44			ACJI: no difference between techniques
Kocaoglu et al. [35]	CC reconstruction/autogenic palmaris Longus graft/GraftRope system	16	39.7	44.9 months	ASES: superior in patients with CC reconstruction	Comparison to the uninjured side: mean 1.1 mm	Retrospective Cohort study/II	Loss of reduction in both groups, higher in the Weaver Dunn group
Kocaoglu et al. [35]	Modified Weaver Dunn + Tightrope	16			CMS: superior in patients with CC reconstruction	Comparison to the uninjured side: mean 3.3 mm	Retrospective Cohort study/II
Yin J et al. [37]	Hook plate + double tunnel CC reconstruction/conjoint tendon graft	25	46	19.9 months	CS: 89.5	Increase in the CC distance after the removal of the hook plate by 25–100%	Case-control study/III	Pain and swelling at the site of tendon harvest
					ASES: 92.6
					VAS: 2.5
	Hook plate	26	44.5	21–27 months	CS: 79.3			Acromion erosion: 46%
					ASES: 82.3			Subacromial impingement: 23%
					VAS: 4.1			Subacromial impingement: 23%
Wang et al [23]	CC and AC reconstruction/allogenic tendon	8	49	>48 months	CMS: 94.4	Not reported	Case series/IV	No complications noted
	CC and AC reconstruction/allogenic tendon	8	49		UCLA score: 33.5
	Hook plate fixation	8	41.3		CMS: 93.8
	Hook plate fixation	8	41.3		UCLA score: 34.1
Stein et al [21]	Hook plate	27	37.7	24 months	Taft: 9.4 ± 1.7	Equal loss of reduction CC distance in 24 months	Cohort study/II	No complications noted
	Hook plate	27	37.7		CS: 90.2 ± 7.8
	Arthroscopic double-button	29	34.2		Taft: 10.9 ± 1.1
	Arthroscopic double-button	29	34.2		CS: 95.3 ± 4.4
Chang et al [38]	Hook plate	26	50	11 months	VAS: 4.5 ± 2.3	CC distance similar in both groups	Therapeutic study/II	Subacromial osteolysis: less in the combined technique group.
					UCLA: 19.9 ± 4.9
					ASES: 51.9 ± 17.8
	Hook plate + CC tape augmentation	21	44	9.5 months	VAS: 2.3 ± 1.4
					UCLA: 27.2 ± 4.0
					ASES: 73.8 ± 13.1
Chernchuijit et al [27]	Arthroscopic AC fixation/suture button	29	No difference between age groups	>18 months	SAC: 8	No difference in the CC distance	Retrospective Cohort study/II	Loss of reduction: >50% of patients in the fixation group
	Arthroscopic AC fixation/suture button	29			Nottingham: 10
	Arthroscopic anatomic AC reconstruction/suture tape	29			SAC: 20
	Arthroscopic anatomic AC reconstruction/suture tape	29			Nottingham: 19

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