Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2025 Apr 30;5(3):477-486.
doi: 10.1016/j.xrrt.2025.04.002. eCollection 2025 Aug.

Tightrope vs. hook plate fixation for acute acromioclavicular joint dislocation: a systematic review and meta-analysis

Brandon Lim  1 , Ariel Chai  1 , Samher Jassim  2 , Mohamed Shaalan  2
Affiliations
Review

Tightrope vs. hook plate fixation for acute acromioclavicular joint dislocation: a systematic review and meta-analysis

Brandon Lim et al. JSES Rev Rep Tech. .

Abstract

Background: Treatment for acromioclavicular joint (ACJ) dislocations aims to restore joint congruity and mechanical stability. However, the best operative technique remains a controversial issue. This systematic review and meta-analysis thus aim to compare the clavicular hook plate (HP) vs. the TightRope (TR) in the management of ACJ dislocation.

Methods: A systematic search was conducted using Embase, Scopus, PubMed, and Web of Science databases to retrieve all relevant studies. Outcomes were operative time (minutes), intraoperative blood loss (mL), clinical outcome measures, postoperative coracoclavicular distance (CCD), and complications. The methodological quality of studies was assessed using the Methodological Index for Nonrandomized Studies tool for nonrandomized studies, and the Cochrane Risk of Bias 2 tool for randomized control trials.

Results: The literature search yielded 221 studies, of which 12 studies enrolling a total of 683 patients were included in this review, with 371 in the HP group and 312 in the TR group. Meta-analysis of comparative studies between HP and TR fixation showed that HPs had better Constant-Murley scores (mean difference (MD), -3.56; 95% confidence interval (CI), -5.37 to -1.75; P = .0001), and less intraoperative blood losses (MD, 41.27; 95% CI, 30.67-51.87; P < .00001). Conversely, TR fixation had better visual analog scale scores (MD, 0.55; 95% CI, 0.34-0.76; P < .0001), and shorter postoperative CCD (MD, 0.45; 95% CI, 0.19-0.71; P = .0008). There was no significant difference in operative time (MD, 1.75; 95% CI, -16.55-20.05; P = .85), University of California, Los Angeles shoulder scores (MD, 0.34; 95% CI, -0.81 to 1.48; P = .56), American Shoulder and Elbow Surgeons scores (MD, 0.39; 95% CI, -0.90 to 1.68; P = .55), and complications (OR, 2.57; 95% CI, 1.00-6.62; P = .05).

Conclusion: TR fixation in ACJ dislocations had similar operative times, complication rates, University of California, Los Angeles scores, and American Shoulder and Elbow Surgeons scores to HP fixation. The HP group had less intraoperative blood loss and better Constant-Murley scores. Conversely, TR fixation had better visual analog scale scores and smaller postoperative CCD. Future randomized control trials on this subject would aid in increasing the validity of our findings.

Keywords: Acromioclavicular joint; Clavicle; Clavicular hook plate; Dislocation; Surgical treatment; TightRope.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Flowchart of study screening and selection using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.
Figure 2
Figure 2
Forest plot of operative time (minutes). HP, hook plate; TR, TightRope; SD, standard deviation.
Figure 3
Figure 3
Forest plot of intraoperative blood loss (mL). HP, hook plate; TR, TightRope; SD, standard deviation; CI, confidence interval.
Figure 4
Figure 4
Forest plot of Constant-Murley scores. HP, hook plate; TR, TightRope; SD, standard deviation; CI, confidence interval; CMS, Constant-Murley score.
Figure 5
Figure 5
Forest plot of visual analog scale scores. HP, hook plate; TR, TightRope; SD, standard deviation; CI, confidence interval; VAS, visual analog scale.
Figure 6
Figure 6
Forest plot of University of California, Los Angeles scores. HP, hook plate; TR, TightRope; SD, standard deviation; CI, confidence interval; UCLA, University of California Los Angeles.
Figure 7
Figure 7
Forest plot of American Shoulder and Elbow Surgeons scores. HP, hook plate; TR, TightRope; SD, standard deviation; CI, confidence interval; ASES, American Shoulder and Elbow Surgeons.
Figure 8
Figure 8
Forest plot of coracoclavicular distance (mm). HP, hook plate; TR, TightRope; SD, standard deviation; CCD, coracoclavicular distance; CI, confidence interval.
Figure 9
Figure 9
Forest plot of complication rates. HP, hook plate; TR, TightRope; CI, confidence interval.
Figure 10
Figure 10
Forest plot of loss of reduction. HP, hook plate; TR, TightRope; CI, confidence interval.
See this image and copyright information in PMC

References

    1. Andreani L., Bonicoli E., Parchi P., Piolanti N., Michele L. Acromio-clavicular repair using two different techniques. Eur J Orthop Surg Traumatol. 2014;24:237–242. doi: 10.1007/s00590-013-1186-1. - DOI - PubMed
    1. Balke M., Schneider M.M., Shafizadeh S., Bäthis H., Bouillon B., Banerjee M. Current state of treatment of acute acromioclavicular joint injuries in Germany: is there a difference between specialists and non-specialists? A survey of German trauma and orthopaedic departments. Knee Surg Sports Traumatol Arthrosc. 2015;23:1447–1452. doi: 10.1007/s00167-013-2795-2. - DOI - PubMed
    1. Bin Abd Razak H.R., Yeo E.-M.N., Yeo W., Lie T.-T.D. Short-term outcomes of arthroscopic TightRope fixation are better than hook plate fixation in acute unstable acromioclavicular joint dislocations. Eur J Orthop Surg Traumatol. 2018;28:869–875. doi: 10.1007/s00590-017-2095-5. - DOI - PubMed
    1. Bradley J.P., Elkousy H. Decision making: operative versus nonoperative treatment of acromioclavicular joint injuries. Clin Sports Med. 2003;22:277–290. doi: 10.1016/S0278-5919(02)00098-4. - DOI - PubMed
    1. Cai L., Wang T., Lu D., Hu W., Hong J., Chen H. Comparison of the tight rope technique and clavicular hook plate for the treatment of rockwood type III acromioclavicular joint dislocation. J Invest Surg. 2018;31:226–233. doi: 10.1080/08941939.2017.1305022. - DOI - PubMed

LinkOut - more resources