Treatment of type 5 acromioclavicular separation with minimal invasive closed-loop double-endobutton technique

Abstract

Abstract Background: Acromioclavicular (AC) separation ranks among the prevalent shoulder girdle injuries, accounting for 50% of all sports-related shoulder ailments. Surgical intervention is advocated for type IV-VI injuries. AC joint congruity and the anatomical integrity of the coracoclavicular (CC) ligament complex are prerequisites for robust scar tissue healing. As such, the aim of our study was to describe our technique of indirect osteosynthesis, using a minimally invasive closed-loop double endobutton (TightRope) technique for fixation of type 5 AC separation, and to evaluate the short-term clinical outcomes and complications. Methods: Fifty-one patients with a Rockwood type 5 AC separation were treated surgically using the TightRope fixation, between January 2017 and December 2021. Clinical and radiological results were assessed using the Constant-Murley score, with concurrent documentation of any complications. Results: In this study, the distribution of cases across the respective groups was as follows: 16 cases in the well-reduced group (31.4%), 5 cases in the incomplete reduction group (9.8%), 20 cases in the partial loss of reduction group (39.2%), and 10 cases in the failure of reduction group (19.6%). Notably, there were no statistically significant differences observed among the first three groups, whereas the complete loss of reduction group demonstrated a significantly lower Constant-Murley score. Conclusion: The Tightrope system offers strength for Rockwood type 5 AC separation, yielding favorable clinical outcomes; however, radiographic findings may not be entirely satisfactory. Partial reduction loss had minimal impact, but complete loss had inferior results. Precise Tightrope placement, ensuring button perpendicularity and avoiding coracoid tip positioning is crucial.