Management of Grade III acromioclavicular joint dislocation using arthroscopic tight rope fixation

Abstract

The treatment of Grade III acromioclavicular joint (ACJ) dislocations has been a subject of much controversy, even as early as Hippocrates. We hypothesized that this surgical technique would improve patient functional outcome. Methods and Results We present a case series of 17 patients all of whom have had grade III dislocations of the ACJ. The patient population was young active adults. Surgery was performed within four weeks in all cases. One Surgeon in the Queen Elizabeth hospital, University of Birmingham, performed the same procedure on all 17 patients. A standard technique was used for tight rope fixation. The fixation device is comprised of no. 5 fibrewire suture and 2 metal buttons, joined by a continuous loop. This is a low-profile double-metallic button technique. Postoperatively all patients remained in a polysling for three weeks and postoperative rehabilitation was commenced after that point including physiotherapy supervised pendular exercises and gentle passive movements. They were all seen six weeks and three months post operatively. Clinical and radiographic assessment was performed to assess the fixation. Of our cohort of patients, one required revision open stabilization after sustaining a mechanical fall on the affected operated side. There was a failure of fixation in a patient who was non-compliant with postoperative instructions. At three months postoperatively all patients were satisfied with the functional outcome and were able to return to pre injury level of activity. Bar the two failures the average OSS was 45.2 (range 40–48). 14 patients returned to their pre injury occupation and sports fitness. Conclusion This technique provides a simple, reproducible, minimally invasive technique for acute ACJ dislocation, which expedites a functional recovery of this acute injury. It is a non-rigid fixation of the AC joint that maintains reduction yet allowing for normal movement at the joint.