Surgical treatment of acute complete acromioclavicular dislocation: comparison of coracoclavicular screw fixation supplemented with tension band wiring or ligament transfer.

Abstract

BACKGROUND: Treatment of acute complete acromioclavicular (AC) dislocation is still controversial. Both non-surgical and surgical methods have been reported with similar results. In addition, once surgical treatment is chosen, a satisfactory surgical technique has not been developed yet. METHODS: Sixty consecutive patients who sustained 60 acute complete AC dislocations were treated using coracoclavicular (CC) screw fixation supplemented with tension band wiring for the AC joint (n = 30) or coracoacromial (CA) ligament reconstruction (n = 30), respectively. The operating times, functional outcomes, and complications were compared. RESULTS: Twenty-nine patients with tension band wiring (group 1) and 27 patients with CA ligament reconstruction (group 2) were followed-up for 12-47 (mean, 23.6) months. The operating time was 34-57 (mean, 46.3) minutes in group 1 verse 52-93 (mean, 83.4) minutes in group 2 (p < 0.001). The percentage of satisfactory outcomes was 86.2% in group 1 verse 88.9% in group 2 (p = 0.30). Loss of reduction of the AC joint was 13.8 % (4/29) in group 1 verse 3.7% in group 2 (1/27, p = 0.17). Patients who received tension band wiring treatment had a higher rate of unsatisfactory outcomes when loss of reduction of the AC joint occurred (p = 0.01). CONCLUSIONS: Once surgical methods are chosen in patients with acute complete AC dislocation, CC screw fixation supplemented with tension band wiring for the AC joint or CA ligament reconstruction achieved similar satisfactory rates. However, patients who received the former had relatively shorter operating times.