Sling reconstruction of acromioclavicular joint dislocation: is screw fixation necessary?

Abstract

Background Acromioclavicular joint injuries have been in much controversy with regard to the ideal method of treatment. The loop technique has been successfully used to stabilize this joint with variable success. Adding a Bosworth screw to the loop fixation may improve its efficacy and decrease the incidence of postoperative subluxation. This comparative study evaluates the efficacy of loop fixation for both acromioclavicular and coracoclavicular ligament reconstruction versus a loop combined with Bosworth screw with regard to function, radiology, and fixation-related complications. Patient and methods Over a 5-year period, we treated 50 patients with acute acromioclavicular joint dislocations with two methods of fixation. Only 47 patients continued follow-up. Group I (N=24) was managed with reconstruction of the coracoclavicular and acromioclavicular ligaments by means of loop fixation. In group II (N=23), a Bosworth screw was added to the loop fixation. Results The mean follow-up period was 24.2±5.9 months (range: 15–34 months) for the first group and 23.3±6.5 months (range: 13–36 months) for the second group. The mean postoperative pain score (visual analog scale) was 1.38±1.7 for group I and 1.35±1.27 for group II. The mean Constant score was 90.2±8.1 for group I and 92.2±5.5 for group II. The mean Taft score was 10.6±1.4 and 10.9±1.3 in the first and second groups, respectively. Recurrence was detected in four patients, two in each group. There was no statistically significant difference in results between the two groups. Conclusion Sling technique was found efficient enough to maintain stability of the acutely dislocated acromioclavicular joint without the need to augment this reconstruction with a screw.