Comparative analysis of arthroscopic-assisted Tight-rope technique and clavicular hook plate fixation in the treatment of Neer type IIB distal clavicle fractures.

BACKGROUND: The aim of the present study was to compare the clinical efficacy of arthroscopic-assisted fixation using the Tight-rope system and clavicular hook plate fixation in the treatment of Neer IIB distal clavicle fractures. METHODS: We enrolled 48 consecutive patients with Neer IIB distal clavicle fractures who were treated at our institution from February 2016 and August 2020. These patients were divided into 2 groups based on the fixation method (16 cases with Tight-rope system and 32 cases with clavicular hook plate), and demographics and clinical characteristics of patients in different groups were compared. RESULTS: All 48 patients had functional outcome scores of the affected shoulder available at a mean of 23.8 ± 5.1 months, and there was a statistically significant improvement in the constant score, American shoulder and elbow surgeons (ASES) score, visual analogue scale (VAS) score at the end of follow-up (p < 0.001 respectively). However, the smaller length of skin incision, less estimated blood loss and shorter hospital stay were detected in the Tight-rope technique group patients than those of clavicular hook plate group patients (p < 0.001, respectively). Furthermore, the constant score, ASES score and VAS score were significantly improved in the Tight-rope technique group patients than those of clavicular hook plate group patients (p < 0.05, respectively). CONCLUSIONS: Both Tight-rope technique and clavicular hook plate fixation can provide satisfactory clinical and radiological results in the treatment of distal clavicular Neer IIB fracture. However, arthroscopic-assisted fixation using the Tight-rope technique showed better results in terms of length of hospital stay, surgical trauma, clinical scores, and diagnose and treat concomitant glenohumeral pathologies. LEVELS OF EVIDENCE: III, Case-control study Retrospective comparative study.

Comparison of clinical efficacy between arthroscopically assisted Tight-Rope technique and clavicular hook plate fixation in treating acute high-grade acromioclavicular joint separations.

INTRODUCTION: The purpose of this study was to compare the results of arthroscopically assisted reduction of acute acromioclavicular (AC) joint separations with the Tight-Rope technique with results of clavicular hook plate fixation. MATERIALS AND METHODS: The 28 patients with acute high-grade AC joint dislocation were treated with arthroscopic assisted fixation using the Tight-Rope system, the arthroscopic evaluation and treatment of glenohumeral lesions were performed before AC ligament reconstruction. Each Tight-Rope technique group patient was matched with three controls that underwent clavicular hook plate fixation, and preoperation and postoperative visual analogue scale (VAS) and functional recovery (Constant Score) of the shoulder joint was assessed,. Furthermore, the demographics and clinical characteristics were compared between the two groups. RESULTS: All patients had clinical and radiological results available at 2 years or greater (mean: 34; range: 24-72 months), they were statistically significant improvement in the constant score and VAS score at the end of follow-up respectively (P < 0.001). Compared with the clavicular hook plate group, Tight-Rope system group patients were incurred significant statistically lower skin incision, hospitalization time and estimated blood loss (P < 0.001), and the constant score and VAS score at the end of follow-up was significantly higher in the Tight-Rope group (P < 0.001). Patients who underwent clavicular hook plate had a higher incidence of fixation failure [10 cases (11.9%) versus 2 cases (7.1%)] than those of the Tight-Rope system group. CONCLUSIONS: The Tight-Rope technique is advantageous for treating these patients because it is a minimally invasive procedure with low complications and superior clinical outcomes.

The Tight-Rope Technique versus Clavicular Hook Plate for Treatment of Acute Acromioclavicular Joint Dislocation: A Systematic Review and Meta-Analysis.

Objective: The efficacy of the tight-rope (TR) technique and clavicular hook plate (CHP) for the treatment of acute acromioclavicular (AC) joint dislocation is controversial. This meta-analysis aimed to evaluate which method is more appropriate for the treatment of acute AC joint dislocation. Methods: We systematically searched the PubMed, EMBASE, Scopus, ISI Web of Science, Chinese VIP Database, and Chinese Wan-Fang databases from inception to January 2018 using the search term "acromioclavicular joint dislocation AND hook plate." All prospective and retrospective controlled trials that had compared functional scores, pain scores, reduction loss rates, coracoclavicular (CC) distances, and complications between TR and CHP for acute AC joint dislocation were identified. A total of 13 of 587 studies with 732 patients were included. TR was preferential to CHP for AC joint dislocation given its higher Constant-Murley score, lower Visual Analog Scale pain score, and comparable reduction loss rate and CC distance. Subgroup analyses of the surgical type of TR did not affect the outcome. Results: The TR technique appears to be associated with better functional recovery and less pain than CHP. In addition, it does not increase the risk of reduction loss, CC distance, or operation time. It is also not associated with other complications except the implant migration, and does not require removal of the internal fixation. Conclusions: Thus, our results indicated that for AC joint dislocation, the TR technique may be preferential.

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

BACKGROUND: This study was conducted to compare the clinical and radiological outcomes of the locking hook plate fixation (HP) technique and the single tight rope (TR) technique applied for acute high-grade acromioclavicular (AC) joint separations. METHODS: Between 2009 and 2014, 135 consecutive patients with acute AC joint separation Rockwood types III, IV, and V were subjected to surgical reconstruction. One hundred fourteen patients (84.4%) were available for retrospective evaluation. Of them, 62 and 52 were treated using the single TR group and clavicular HP group techniques, respectively. The visual analogue scale, Constant, American Shoulder and Elbow Surgeons (ASES), and Taft scores were used for clinical assessment. Postoperative shoulder range of motion was also assessed. An anteroposterior radiograph of the coracoclavicular distance (CCD) was obtained to evaluate the radiographic signs of recurrence. RESULTS: The TR group patients had better Constant, ASES, and Taft scores than the HP group patients. The loss of reduction in terms of the CCD did not differ between groups. Subacromial osteolysis was observed in 34.6% of the cases in the HP group. However, there were no significant differences in the clinical outcomes between the patients with and without osteolysis in the HP group. Subcoracoid osteolysis, drill tunnel widening, and metal displacement were observed in 3.2%, 22.6%, and 4.8% of the cases in the TR group, respectively. CONCLUSIONS: The single TR technique was relatively more effective at treating acute high-grade AC joint injuries than the HP fixation technique (level of evidence: therapeutic; retrospective comparative study, Level III).

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

BACKGROUND: This study was conducted to compare the clinical and radiological outcomes of the locking hook plate fixation (HP) technique and the single tight rope (TR) technique applied for acute high-grade acromioclavicular (AC) joint separations. METHODS: Between 2009 and 2014, 135 consecutive patients with acute AC joint separation Rockwood types III, IV, and V were subjected to surgical reconstruction. One hundred fourteen patients (84.4%) were available for retrospective evaluation. Of them, 62 and 52 were treated using the single TR group and clavicular HP group techniques, respectively. The visual analogue scale, Constant, American Shoulder and Elbow Surgeons (ASES), and Taft scores were used for clinical assessment. Postoperative shoulder range of motion was also assessed. An anteroposterior radiograph of the coracoclavicular distance (CCD) was obtained to evaluate the radiographic signs of recurrence. RESULTS: The TR group patients had better Constant, ASES, and Taft scores than the HP group patients. The loss of reduction in terms of the CCD did not differ between groups. Subacromial osteolysis was observed in 34.6% of the cases in the HP group. However, there were no significant differences in the clinical outcomes between the patients with and without osteolysis in the HP group. Subcoracoid osteolysis, drill tunnel widening, and metal displacement were observed in 3.2%, 22.6%, and 4.8% of the cases in the TR group, respectively. CONCLUSIONS: The single TR technique was relatively more effective at treating acute high-grade AC joint injuries than the HP fixation technique (level of evidence: therapeutic; retrospective comparative study, Level III).

Operative treatment of acute acromioclavicular joint injuries graded Rockwood III and IV: risks and benefits in tight rope technique vs. k-wire fixation.

BACKGROUND: Operative treatment of acromioclavicular joint injuries is recommended for higher degree dislocations. Recently a new option has become available with the minimally-invasive tight rope technique. Whereas clinical studies justify the medical use, risks and benefits remain unclear. Therefore, this study analyzed these facts associated with this procedure and compared them to K-wire fixation. MATERIAL AND METHODS: A retrospective analysis was performed of patients surgically treated either with the TightRope™-technique (TR) or K-wires (KW) for a first event isolated Rockwood type III or higher acromioclavicular joint dislocation between 2004 and 2011. Timing for surgery, surgical duration, length of hospital stay, costs, complications and outpatient visits were recorded. RESULTS: 41 patients were included (TR: n = 18; KW: n = 23) with comparable demographics and injury severity. A trend towards shorter operation time was seen in the TR group (TR: 64.3 ±19.8 min. vs. KW: 80.9 ±33.7 min., n.s.) A tendency for lower total operation theater costs was seen in the TR group (TR: 474 ±436.5€ vs. KW: 749.1 ±31.2€, n.s.). Patients from the TR group left hospital earlier (TR: 2 ±1d vs. KW: 3.6 ±1.8d, p = 0.002). Severe complications (i.e. a fracture of the clavicle or nerve damage) occurred in neither of the groups. Early loss of reduction (n = 1) and impaired wound healing (n = 2) was seen in the TR group. Migrating K-wires (n = 4), loss of reduction (n = 1) and impingement syndrome (n = 1) were recorded in the KW group. CONCLUSION: Usage of the tight rope technique offered advantages, such as being a safe minimally-invasive technique and showed a tendency towards shorter operation time, and lower physician- and total operation and theater costs. Material costs were significantly higher for this device but patients were discharged earlier. The influence of different clinical long-term results on the financial outcome needs to be evaluated in further studies.