Outcome of Hook-plate Fixation without CC Ligament Repair in Acute ACJ Dislocation

Background: Acromio-clavicular joint (ACJ) dislocation is a common injury of the upper limb. Most patients are treated conservatively. However, active patients, laborers, who have ACJ dislocation grades 3-5 may require surgery. Reduction and stabilization of the AC joint with hook plate is one of the accepted methods to treat these patients. The purpose of this study was to evaluate the clinical and radiological outcomes of patients with ACJ dislocation who were treated with hook-plate fixation without surgical reconstruction/repair of the CC ligaments.

Methods: 20 patients with an acute ACJ dislocations and underwent surgery within few days thereafter, created the cohort of this study. There were 11 type 3 dislocation and 9 with type 5 (Rockwood classification). All patients were treated with a hook-plate, without repairing or reconstructing the CC ligaments. All patients had their plate removed few months later. Follow up was performed at least 12 months after the index surgery, and included: assessment of the affected shoulder, x-ray of the ACJ, VAS, DASH, SANE and Constant Shoulder Score.

Results: 19/20 (95%)of the cases achieved anatomical reduction, who had a residual type 2 dislocation on final x-rays. 17 patients (85%) reported no or only mild pain while 3 reported moderate pain. Average SANE score was 85.8±10.6‏, VAS score 1.1±1.8‏ and DASH score 12.1±14.3. In 2 patients (10%) significant narrowing and irregularity of the ACJ was found in the x-ray evaluation.

Conclusions: Acute type 3-5 ACJ dislocation stabilization using hook plate can achieve good and stable without the need to repair/augment the CC ligaments. Good functional outcome can be expected in most patients, however arthritic changed can be found in the ACJ that may explain some of the residual pain in the patients.