Knee Surgery, Sports Traumatology, Arthroscopy

, Volume 26, Issue 12, pp 3832–3847 | Cite as

Return to sport after acute acromioclavicular stabilization: a randomized control of double-suture-button system versus clavicular hook plate compared to uninjured shoulder sport athletes

  • D. Müller
  • Y. Reinig
  • R. Hoffmann
  • M. Blank
  • F. Welsch
  • U. Schweigkofler
  • T. SteinEmail author



Traumatic high-grade acromioclavicular joint (ACJ) separations can be surgically stabilized by numerous anatomic and non-anatomic procedures. The return to sport (Maffe et al. in Am J Sports Med 23:93–98, 1995] and remaining sport-associated impairments after acute ACJ stabilization has not yet been investigated.


73 consecutive athletes with acute high-grade ACJ separation were prospectively assigned into two groups (64.4% randomized, 35.6% intention-to-treat): open clavicular hook plate (cHP) implantation (GI) or arthroscopically assisted double double-suture-button (dDSB) implantation (GII). Patients were analyzed using shoulder sport-specific measurement tools for sport ability (ASOSS), sport activity (SSAS), and numerical analog scales: NASpain during sport, NASshoulder function in sport, and NASre-achievement of sport level. Four points of examination were established: preoperative evaluation (FU0) and first postoperative follow-up (FU1) at 6 months; FU2 at 12 months; and FU3 at 24 months after surgery. The control group (GIII) consisted of 140 healthy athletes without anamnesis of prior macro-injury or surgery.


After surgical stabilization, 29 of 35 athletes in GI (82.9%; 38.6 ± 9.9 years) and 32 of 38 in GII (82.9%; 38.6 ± 9.9 years) were followed up for 24 months (FU3) (loss 17.8%). All operated athletes showed significantly increased scores compared to FU0 (p < 0.05). Compared to GI, GII showed significantly superior outcome data for sporting ability as well as for NASre-achievement of sport level (p < 0.05). While GII re-achieved GIII-comparable SSAS and ASOSS levels, GI remained at a significantly inferior level. Athletes after ACJ injury of Rockwood grade IV/V and overhead athletes benefited significantly from the dDSB procedure.


The dDSB procedure enabled significantly superior sport-specific outcomes compared to the cHP procedure. Athletes after dDSB surgeries re-achieved the sporting ability and the sport activity levels of healthy athletes, whereas athletes after cHP implantation remained at significantly inferior levels. The more extensive dDSB procedure and the more restrictive rehabilitation are recommended for treatment of acute high-grade ACJ separations of functionally high-demanding athletes.

Level of evidence



Acute acromioclavicular separation Acromioclavicular joint (ACJ) Arthroscopically assisted acromioclavicular joint stabilization Double-CC-bundle acromioclavicular joint stabilization Sports activity after ACJ stabilization 



The authors appreciate the assistance of Dr. rer. med. Hanns Ackermann for collection and analyzing the data.


No funding exists.

Compliance with ethical standards

Conflict of interest

T. Stein has received payment for instructional courses. Other authors declare that they have no conflict of interest.

Ethical approval

The institutional ethics committee approved all data-collection and randomising procedures (clinical trial registry number: FF 42/2011).

Informed consent

All subjects provided informed consent.


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Copyright information

© European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA) 2018

Authors and Affiliations

  1. 1.Department of Sporttraumatology-Knee- and Shoulder-SurgeryBerufsgenossenschaftliche Unfallklinik Frankfurt am MainFrankfurtGermany
  2. 2.Department of Trauma and Orthopedic SurgeryBerufsgenossenschaftliche Unfallklinik Frankfurt am MainFrankfurtGermany
  3. 3.Department of Sports ScienceUniversity of BielefeldBielefeldGermany
  4. 4.Department of Trauma, Hand and Reconstructive SurgeryUniversity Hospital Frankfurt am MainFrankfurtGermany

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