The Tight-Rope technique was found to be superior to clavicular hook plate fixation for acromioclavicular joint separation in a new study.
Using a Tight-Rope for Acromioclavicular Joint Separation
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Secondary#tightropesystem#acromioclavicularjointseparation#clavicularhookplatefixation
The researchers of “Comparison of Clinical Efficacy Between Arthroscopically Assisted Tight-Rope Technique and clavicular hook plate fixation in treating acute high-grade acromioclavicular joint separations,” published online on April 26, 2021 in the Journal of Orthopaedic Surgery, compared the results of arthroscopically assisted reduction of acute acromioclavicular joint separations with the Tight-Rope technique with results of clavicular hook plate fixation.
“Traumatic injury of the acromioclavicular (AC) joint runs up to 9% of all shoulder injuries in human beings. Recent epidemiological studies showed that around 60,000 new cases were diagnosed with complete dislocations (Rockwood type’s ≥III) every year. Treatment of AC joint separations remain controversial,” they wrote.
Each of the 28 patients who underwent arthroscopic assisted fixation of high-grade acromioclavicular joint separation using the Tight-Rope System were matched to 3 controls that had clavicular hook plate fixation instead.
Primary outcomes included pre-operative and post-operative Visual Analogue Scale (VAS) and functional recovery (Constant Score) of the shoulder joint. Clinical and radiological results were available at 2 years or greater (mean: 34; range: 24-72 months).
All patients experienced significant improvement in the Constant Score and VAS score at the end of the follow-up (p < 0.001). However, the Tight-Rope system group had lower skin incision, hospitalization time, and estimated blood loss (p < 0.001).
The Constant Score and VAS score at the end of the follow-up was also significantly higher in the Tight-Rope group (p < 0.001). Patients in the clavicular hook plate group had a higher rate of fixation failure [10 cases (11.9%) vs 2 cases (7.1%] than the those in the Tight-Rope system group.
“The Tight-Rope technique is advantageous for treating these patients because it is a minimally invasive procedure with low complications and superior clinical outcomes,” the researchers wrote.
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This is a fascinating development. In my practice we've seen similar outcomes with the revised protocol. The key differentiator seems to be patient selection criteria. Has anyone else noticed the correlation with BMI thresholds?
Great point. I'd push back slightly on the conclusion, the sample size in the cited study is too small to draw population-level inferences. That said, the directional signal is compelling and worth a larger RCT.
We implemented a similar approach last year. Early results are promising but we're still gathering 12-month follow-up data. Happy to share our protocol if anyone is interested.
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