Knee Surgery, Sports Traumatology, Arthroscopy

, Volume 22, Issue 2, pp 422–430 | Cite as

Has the arthroscopically assisted reduction of acute AC joint separations with the double tight-rope technique advantages over the clavicular hook plate fixation?

  • Gunnar Jensen
  • Jan Christoph Katthagen
  • Laura Esther Alvarado
  • Helmut Lill
  • Christine Voigt



The purpose of this study was to compare the results after arthroscopically assisted double TightRope®—(TR) reduction with results after clavicular hook plate (HP) fixation in acute high-grade acromioclavicular (AC) joint separations.


Between 2004 and 2010, 69 consecutive patients with acute AC joint separations type Rockwood III and V were subjected to surgical reconstruction. 56 patients (81 %) were available for evaluation. Thereof, 30 (median age: 39 years; n = 12 acute Rockwood III and n = 18 Rockwood V injuries) were treated by a clavicular HP and 26 (median age: 39 years; n = 10 acute Rockwood III and n = 16 Rockwood V injuries) using the double TR technique. Group HP was evaluated at a median of 48 (7–77) months after surgery and the TR group 17 (7–29) months after stabilization. Visual Analogue Scale (VAS) for Pain, Simple Shoulder Test (SST), Constant Score (CS) and Taft Score (TS) were assessed. Sonographic measurements were performed to evaluate recurrent instability.


Clinical examination demonstrated comparable results without significant differences. In the groups HP and TR, the VAS was median 0.8 (range, 0.0–7.5) and 0.4 (range, 0.0–5.7), the SST reached median 11 (range, 0–12 points) and 12 points (range, 8–12 points). The CS was median 92.4 % (range, 21.5–105.4 %) and 94.0 % (range, 54.6–105.3 %) and the TS median 10 (range, 3–12 points) and 10 points (range, 5–12 points). Sonographic measurements showed a mean coracoclavicular (CC) distance of 25.3 ± 4.5 (HP) and 25.5 ± 4.3 mm (TR) (n.s.). In both groups, CC distance of the operated side was significantly higher compared to the uninjured side. The complication rate was 13 % in group HP and 12 % in group TR.


In acute high-grade AC joint instabilities, both techniques lead to mostly good and excellent clinical results, although comparable partial recurrent vertical instability could be observed. Diagnosis and therapy of concomitant glenohumeral injuries and no obligatory implant removal are advantages of the arthroscopic procedure.

Level of evidence

Therapeutic; retrospective comparative study, Level III.


Acromioclavicular joint Acute separation Arthroscopically stabilization TightRope®-technique Clavicular hook plate 


Conflict of interest

The authors declare that there is no conflict of interest.


  1. 1.
    Alexander OM (1949) Dislocation of the acromioclavicular joint. Radiography 15(179):260PubMedGoogle Scholar
  2. 2.
    Ceccarelli E, Bondì R, Alviti F, Garofalo R, Miulli F, Padua R (2008) Treatment of acute grade III acromioclavicular dislocation: a lack of evidence. J Orthop Traumatol 9(2):105–108PubMedCrossRefGoogle Scholar
  3. 3.
    Chernchujit B, Tischer T, Imhoff AB (2006) Arthroscopic reconstruction of the acromioclavicular joint disruption: surgical technique and preliminary results. Arch Orthop Trauma Surg 126:575–581PubMedCrossRefGoogle Scholar
  4. 4.
    Chiang CL, Yang SW, Tsai MY, Kuen-Huang Chen C (2010) Acromion osteolysis and fracture after hook plate fixation for acromioclavicular joint dislocation: a case report. J Shoulder Elbow Surg 19(4):e13–e15PubMedCrossRefGoogle Scholar
  5. 5.
    Coale RM, Hollister SJ, Dines JS, Allen AA, Bedi A (2012) Anatomic considerations of transclavicular-transcoracoid drilling for coracoclavicular ligament reconstruction. J Shoulder Elbow Surg. doi: 10.1016/j.jse.2011.12.008
  6. 6.
    Constant CR, Murley AH (1987) A clinical method of functional assessment of the shoulder. Clin Orthop Relat Res 214:160–164PubMedGoogle Scholar
  7. 7.
    De Baets T, Truijen J, Driesen R, Pittevils T (2004) The treatment of acromioclavicular joint dislocation Tossy grade III with a clavicle hook plate. Acta Orthop Belg 70(6):515–519PubMedGoogle Scholar
  8. 8.
    ElMaraghy AW, Devereaux MW, Ravichandiran K, Agur AM (2010) Subacromial morphometric assessment of the clavicle hook plate. Injury 41(6):613–619PubMedCrossRefGoogle Scholar
  9. 9.
    Fenkl R, Gotzen L (1992) Sonographic diagnosis of the injured acromioclavicular joint. A standardized examination procedure. Unfallchirurg 95(8):393–400PubMedGoogle Scholar
  10. 10.
    Gerhardt C, Kraus N, Greiner S, Scheibel M (2011) Arthroscopic stabilization of acute acromioclavicular joint dislocation. Orthopäde 40(1):61–69PubMedCrossRefGoogle Scholar
  11. 11.
    Gstettner C, Tauber M, Hitzl W, Resch H (2008) Rockwood type III acromio-clavicular dislocation: surgical versus conservative treatment. J Shoulder Elbow Surg 17(2):220–225PubMedCrossRefGoogle Scholar
  12. 12.
    Hackenberger J, Schmidt J, Altmann T (2004) The effects of hook plates on the subacromial space–a clinical and MRT study. Z Orthop Ihre Grenzgeb 142(5):603–610PubMedCrossRefGoogle Scholar
  13. 13.
    Hoffler CE, Karas SG (2010) Transacromial erosion of a locked subacromial hook plate: case report and review of literature. J Shoulder Elbow Surg 19(3):e12–e15PubMedCrossRefGoogle Scholar
  14. 14.
    Irlenbusch U (2012) Examination techniques of the shoulder—expert’s evaluation based on literature analysis. Obere Extremitat 7(1):61Google Scholar
  15. 15.
    Katolik LI, Romeo AA, Cole BJ, Verma NN, Hayden JK, Bach BR (2005) Normalization of the constant score. J Shoulder Elbow Surg 14:279–285PubMedCrossRefGoogle Scholar
  16. 16.
    Kienast B, Thietje R, Queitsch C, Gille J, Schulz AP, Meiners J (2011) Mid-term results after operative treatment of rockwood grade III-V acromioclavicular joint dislocations with an AC-hook-plate. Eur J Med Res 16(2):52–56PubMedCrossRefPubMedCentralGoogle Scholar
  17. 17.
    Kock HJ, Jurgens C, Hirche H, Hanke J, Schmit-Neuerburg KP (1996) Standardized ultrasound examination for evaluation of instability of the acromioclavicular joint. Arch Orthop Trauma Surg 115(3–4):136–140PubMedCrossRefGoogle Scholar
  18. 18.
    Koukakis A, Manouras A, Apostolou CD, Lagoudianakis E, Papadima A, Triantafillou C, Korres D, Allen PW, Amini A (2008) Results using the AO hook plate for dislocations of the acromioclavicular joint. Expert Rev Med Devices 5(5):567–572PubMedCrossRefGoogle Scholar
  19. 19.
    Lippit S, Harrymann DT, Matsen F (1993) A practical tool for evaluation of function: the simple shoulder test. In: Matsen FI, Fu F, Hawkins R (eds) The shoulder: a balance of mobility and stability. American Academy of Orthopedic Surgery, Rosemont, pp 501–518Google Scholar
  20. 20.
    Loew M, Schiltenwolf M, Bernd L (1993) Sonographic diagnosis of injuries of the acromioclavicular joint. Z Orthop 131:302–306PubMedCrossRefGoogle Scholar
  21. 21.
    Mazzocca AD, Arciero RA, Bicos J (2007) Evaluation and treatment of acromioclavicular joint injuries. Am J Sports Med 35(2):316–329PubMedCrossRefGoogle Scholar
  22. 22.
    McConnell AJ, Yoo DJ, Zdero R, Schemitsch EH, McKee MD (2007) Methods of operative fixation of the acromio-clavicular joint: a biomechanical comparison. J Orthop Trauma 21(4):248–253PubMedCrossRefGoogle Scholar
  23. 23.
    Murena L, Vulcano E, Ratti C, Cecconello L, Rola PR, Surace MF (2009) Arthroscopic treatment of acute acromioclavicular joint dislocation with double flip button. Knee Surg Sports Traumatol Arthrosc 17(12):1511–1515PubMedCrossRefGoogle Scholar
  24. 24.
    Patzer T, Clauss C, Kühne CA, Ziring E, Efe T, Ruchholtz S, Mann D (2012) Arthroscopically assisted reduction of acute acromioclavicular joint separations: Comparison of clinical and radiological results of single versus double TightRope™ technique. Unfallchirurg. doi: 10.1007/s00113-001-2135-2
  25. 25.
    Pauly S, Gerhardt C, Haas NP, Scheibel M (2009) Prevalence of concomitant intraarticular lesions in patients treated operatively for high-grade acromioclavicular joint separations. Knee Surg Sports Traumatol Arthrosc 17(5):513–517PubMedCrossRefGoogle Scholar
  26. 26.
    Petersen W, Wellmann M, Rosslenbroich S, Zantop T (2010) Minimally Invasive Acromioclavicular Joint Reconstruction (MINAR). Oper Orthop Traumatol 22(1):52–56PubMedCrossRefGoogle Scholar
  27. 27.
    Phillips A, Smart C, Groom AF (1998) Acromioclavicular dislocation. Conservative or surgical therapy. Clin Orthop Relat Res 353:10–17PubMedCrossRefGoogle Scholar
  28. 28.
    Rockwood CA (1984) Injuries of the acromioclavicular joint. In: Rockwood CA, Greene DP (eds) Fractures in adults, vol 1. Lippincott, Philadelphia, pp 869–872Google Scholar
  29. 29.
    Salem KH, Schmelz A (2009) Treatment of Tossy III acromioclavicular joint injuries using hook plates and ligament suture. J Orthop Trauma 23(8):565–569PubMedCrossRefGoogle Scholar
  30. 30.
    Salzmann GM, Walz L, Schöttle PB, Imhoff AB (2008) Arthroscopic anatomical reconstruction of the acromioclavicular joint. Acta Orthop Belg 74(3):397–400PubMedGoogle Scholar
  31. 31.
    Salzmann GM, Walz L, Buchmann S, Glabgly P, Venjakob A, Imhoff AB (2010) Arthroscopically assisted 2-bundle anatomical reduction of acute acromioclavicular joint separations. Am J Sports Med 38(6):1179–1187PubMedCrossRefGoogle Scholar
  32. 32.
    Sage FP, Salvatore JE (1963) Injuries of the acromioclavicular joint: a study of results in 96 patients. South Med J 56:486–495PubMedCrossRefGoogle Scholar
  33. 33.
    Scheibel M, Dröschel S, Gerhardt C, Kraus N (2011) Arthroscopically assisted stabilization of acute high-grade acromioclavicular joint separations. Am J Sports Med 39(7):1507–1516PubMedCrossRefGoogle Scholar
  34. 34.
    Sim E, Schwarz N, Höcker K, Berzlanovich A (1995) Repair of complete acromioclavicular separations using the acromioclavicular-hook plate. Clin Orthop Relat Res 314:134–142PubMedGoogle Scholar
  35. 35.
    Sluming VA (1995) Technical note: measuring the coracoclavicular distance with ultrasound—a new technique. Br J Radiol 68(806):189–193PubMedCrossRefGoogle Scholar
  36. 36.
    Taft TN, Wilson FC, Oglesby JW (1987) Dislocation of the acromioclavicular joint. An end-result study. J Bone Joint Surg Am 69(7):1045–1051PubMedGoogle Scholar
  37. 37.
    Tischer T, Salzmann GM, El-Azab H, Vogt S, Imhoff AB (2009) Incidence of associated injuries with acute acromioclavicular joint dislocations types III through V. Am J Sports Med 37(1):136–139PubMedCrossRefGoogle Scholar
  38. 38.
    Walz L, Salzmann GM, Fabbro T, Eichhorn S, Imhoff AB (2008) The anatomic reconstruction of acromioclavicular joint dislocations using 2 TightRope devices: a biomechanical study. Am J Sports Med 36(12):2398–2406PubMedCrossRefGoogle Scholar
  39. 39.
    Wei HF, Chen YF, Zeng BF, Zhang CQ, Chai YM, Wang HM, Lu Y (2011) Triple endobuttton technique for the treatment of acute complete acromioclavicular joint dislocations: preliminary results. Int Orthop 35(4):555–559PubMedCrossRefPubMedCentralGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2012

Authors and Affiliations

  • Gunnar Jensen
    • 1
  • Jan Christoph Katthagen
    • 1
  • Laura Esther Alvarado
    • 1
  • Helmut Lill
    • 1
  • Christine Voigt
    • 1
  1. 1.Department of Trauma and Reconstructive SurgeryFriederikenstift Hospital HannoverHannoverGermany

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