Acromioclavicular hook plate versus anatomical reconstruction of coracoclavicular ligaments using hamstring autograft in acromioclavicular joint dislocation
Authors: Amr Rashwan 
Published: November 2021

Introduction
Acromioclavicular joint (ACJ) injuries can result from a multitude of causes. Most injuries occur during activities with high-impact risks such as contact sports, football, ice hockey, and wrestling, with male athletes at greater risk than female athletes. The stability of AC joint depends on the joint capsule, the acromioclavicular (AC) and coracoclavicular (CC) ligaments, and the intraarticular fibrocartilaginous disc. The choice of the required surgical technique for the management of AC disruption is a controversial issue owing to the abundance of the surgical options described for treatment. However, the clinical superiority of these procedures remains debatable, and various complications have been reported.

Hypothesis
This hypothesis is that the anatomical reconstruction of the CC ligaments may render better long-term functional and radiological results compared with the use of a hook plate in ACJ dislocations.

Patients and methods
This is a prospective nonrandomized comparative study that was held between August 2011 and January 2017 at Cairo University Hospitals. It included 64 patients with acute AC dislocation type III–VI and divided into two groups: group A, which underwent anatomic reconstruction of CC and AC ligaments, and group B, which underwent ACJ dislocation using the hook plate. The mean age of group A patients was 43.22±11.46 years, whereas it was 41.56±8.70 years in group B. There were 22 male and 10 female patients in group A compared with 21 male and 11 female patients in group B. The mean time from injury was 8.41±3.41 weeks in group A compared with 9.91±1.59 weeks in group B. The average follow-up was 64.06±4.24 months in group A versus 63.94±3.79 months in group B. The clinical outcome was assessed preoperatively and postoperatively at 1, 2, and 5 years using the visual analog scale, Constant score, and American shoulder and elbow surgeon score. Radiological assessment included the measurement of the CC distance (vertical displacement) and the anteroposterior (horizontal) displacement preoperatively and postoperatively at 1 year and at the final follow-up.

Results
Regarding the clinical outcome, the visual analog scale score improved from 7.06±1.22 preoperatively to 1.06±1.07 at 5-year follow-up in group A, whereas it improved from 7.5±0.92 preoperatively to 2.97±0.59 at 5-year follow-up in group B, with P=0.000. Similarly, the American shoulder and elbow surgeon score improved from 26.64±8.15 preoperatively to 92.06±5.37 postoperatively in group A, whereas in group B, it improved from 19.87±7.56 preoperatively to 77.1±5.40 postoperatively (P=0.000). The constant score in group A improved from 20.44±2.66 preoperatively to 92.91±3.64 postoperatively, and in group B, it improved from 20.13±2.29 preoperatively to 80.53±4.76 postoperatively (P=0.000). The radiological assessment at the final follow-up showed that the anteroposterior (horizontal) displacement in group A was 4.31±2.62 preoperatively and became 1.06±1.01 postoperatively, whereas in group B, it was 5.56±2.12 preoperatively and became 3.41±1.29 postoperatively, with a statistically significant difference (P=0.000). The superior displacement in group A was 21.57±5.09 mm preoperatively and decreased to 10.61±1.02 postoperatively compared with 23.99±5.92 preoperatively, which decreased to 13.36±3.67 postoperatively in group B, with statistically significant difference (P=0.001).

Conclusion
The concomitant anatomical reconstruction of the CC and AC ligaments using autograft provides long-term functional outcome and mechanical stability in both the vertical and horizontal translation compared with the hook plate fixation in acute unstable ACJ dislocation.