Single coracoclavicular suture fixation with Mersilene tape versus hook plate in the treatment of acute type V acromioclavicular dislocation: a retrospective analysis

Abstract

Background: Here, we compared the clinical and radiographic outcomes between coracoclavicular (CC) fixation with Mersilene tape and hook plate for acute unstable acromioclavicular (AC) joint dislocation treatment.

Methods: We enrolled 49 patients with unstable acute AC dislocation who, between January 2010 and January 2014, underwent surgery with single CC suture fixation with Mersilene tape (M group, 25 cases) or clavicle hook plate (H group, 24 cases). In M and H groups, the average age was 43.7 (range 18-72) and 42.0 (range 17-84) years, the male to female ratio of each group was 15:20 and 19:5, and the injured side left to right ratio was 12:13 and 11:13, respectively. All patients were right-handed. We retrospectively compared the operation time, complication rate, visual analog scale (VAS), University of California at Los Angeles (UCLA) shoulder rating scale, Oxford shoulder scores, and the radiographic outcomes based on reduction loss of CC distance on postoperative follow-up.

Results: No significant difference in patient demographics between the two groups in age (p = 0.709), gender (p = 0.217), time from injury to surgery (p = 0.863), and injured side (p = 1.000). The mean follow-up was 26.2 months (range 24-35 months). Nine cases of reduction loss (36%) and one of distal clavicle osteolysis (4%) were noted in the M group. CC distance improvement in the H group was significantly superior to that in the M group at 3 months (before hook plate removal, p < 0.001) and 12 months postoperatively (after hook plate removal, p = 0.004), while subacromial erosions were revealed in nine cases (37.5%) in the H group. No significant difference in operative time (p = 0.846), complication rate (p = 1.000), VAS (p = 0.199), mean UCLA shoulder rating scale (p = 0.353), and Oxford shoulder (p = 0.224) scores between the two groups.

Conclusions: Both hook plate and Mersilene tape fixations provided temporary stabilization of acute type V AC dislocation and yielded comparable clinical outcomes. The hook plate provided better maintenance of reduction of radiographic outcomes. CC suture fixation with Mersilene tape may serve as an alternative method of stabilization which provides acceptable outcome without the need of implant removal.

Keywords: Acromioclavicular dislocation; Coracoclavicular fixation; Hook plate; Loop suspensory fixation; Mersilene tape.

Fig. 1

Flowchart of inclusion and exclusion of participants in current analysis

Fig. 2

Coracoclavicular (CC) suture fixation with Mersilene tape for a type V AC dislocation after motorcycle accident injury. a Preoperative plain radiograph. b 1-month postoperative plain radiograph. c Surgical technique illustration of suspensory sling fixation with Mersilene tape

Fig. 3

Coracoclavicular fixation with hook plate for a type V AC dislocation after motorcycle accident injury. a Preoperative plain radiograph. b 1-month postoperative plain radiograph

Fig. 4

The method of measurement for CC distance

Fig. 5

Reduction loss after coracoclavicular fixation with Mersilene tape. a Preoperative plain radiograph. b 1-month postoperative follow-up. c 6-month postoperative follow-up with reduction failure

Fig. 6

a Osteolysis was observed on the left distal clavicle after CC fixation with Mersilene tape (arrow). b Subacromial erosion at the stress concentration area (arrow) after CC fixation with hook plate

Fig. 7

Radiographic outcomes. The line chart illustrated the trend of CC distance of the M and H groups by postoperative follow-up time