Clavicular hook plate versus dog-bone technique for acute high-grade acromioclavicular joint dislocation – A retrospective cohort study comparing clinical outcome scores, complications and costs

Abstract text (incl. references and figure legends)

Introduction: Arthroscopically assisted coracoclavicular (CC) ligament fixation techniques have been promoted as providing superior outcomes for the treatment of acute high-grade acromioclavicular joint (ACJ) dislocations. Nevertheless, there is a lack of high-level evidence for clinically relevant benefits. At our institute, orthopaedic surgeons use an arthroscopically assisted coracoclavicular ligament fixation technique (DB), while general trauma surgeons use a clavicular hook plate (cHP) technique. The aim of the study was to compare clinical outcomes, complication rates and costs between the two groups.

Materials and Methods: The hospital database was searched for patients treated for acute traumatic high-grade (Rockwood Typ ≥III) ACJ dislocation using either a cHP or arthroscopically assisted DB technique between 2010 and 2019. Seventy-nine patients could be included (56 patients in the cHP group and 23 in the DB group). QuickDASH scores, subjective shoulder value (SSV) scores, pain scores (numerical pain rating scale 10) and complication rates were retrospectively collected through phone interviews and by screening patient charts as well as surgical reports. Costs per patient were obtained from the hospital"s accounting system.

Results: Mean follow-up was 54±33.7 and 45±21.7 months in the cHP and DB group, respectively. QuickDASH and SSV scores did not differ but patients in the cHP group reported significantly lower pain scores (p = 0.033). More patients reported hypertrophic or disturbing scars (p=0.49) and sensibility disturbances (p=0.007) in the cHP group. Three patients suffered from a frozen shoulder in the DB group (p = 0.023).

Conclusion: Patient-reported outcomes are excellent after long-term follow up for both techniques. There are no clinically relevant differences in clinical outcome scores based on our results and a review of the literature. Both techniques certainly have their benefits regarding secondary outcome measures.

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CS reports being a member of the AO Technical Commission (Lower Extremity). None of the other authors, their immediate family received financial payments or other benefits from any commercial entity related to the subject of this article.