Hook plate versus tightrope for acute grade III acromioclavicular dislocation

Abstract

Introduction The different surgical techniques described to treat type III acromioclavicular (AC) dislocation illustrate the fact that the ideal surgery remains controversial. This study aims at comparing two familiar different methods of stabilization of this injury. Patients and methods Between May 2013 and February 2015, 20 patients with acute Rockwood type III AC dislocation were divided into two groups, to compare the functional outcome after using either hook plate or tightrope stabilization. Patients were evaluated using the University of California Los Angeles Shoulder Scoring System. Results Nine patients in the hook plate group were reoperated to remove the device, except one who refused to be reoperated. Only one patient in the tightrope group had revision because of rupture of the tightrope in the fourth week with successful and good outcome. The patients of the hook plate group showed significantly higher incidence of complication in comparison with the tightrope group (40 vs. 10%, respectively). Two (20%) cases in the hook plate group suffered from superficial infection and another two (20%) cases showed signs of osteolysis in 1-year follow-up plain radiographs. There was insignificant difference between both groups regarding severity of pain. The majority (70%) of the tightrope patients regained their normal functional activities, whereas only 40% of the hook plate patients did (P 0.05). Conclusion Open reduction and stabilization with either hook plate or tightrope in type III AC dislocations are effective techniques regarding the objective outcome scores, with no significant differences between the two groups. However, tightrope fixation provides a low rate of failure and complications and avoids the need for second surgery to remove the implant.