Comparative study of surgical treatment of acromioclavicular luxation

Acromioclavicular (AC) luxations most often affect athletes. The published results regarding the treatment of AC joint luxations vary. Each method has its advantages and disadvantages, so there is still no consensus on the best method of treatment. The aim of this study was to review the results of a number of surgical approaches to stabilization of AC joint recorded over the span of five years.

This study was based on the data acquired from the analysis of 28 patients with AC luxation surgically treated in the Clinical Center of Montenegro. One group of 16 patients underwent the traditional AO method (with transfixation of AC joint with Kirschner wire and Zuggurtung tension bands) or the Bosworth method (using the coracoclavicular transfixation screw--Zugg-Bosw group). The second group of 12 patients underwent a newer techinque with the Hook plate (Hook plate group).

All the patients had AC luxation of higher degree, stage IV-VI acording to the Rockwood scale. The average age of the two groups was very similar, with 28 being the average age of the Zugg-Bosw group, and 25 of the Hook plate group. Most patients were males (82%), injured mostly during athletic activity (75%-83%). Complications were more common and more complex in the Zugg-Bosw group, with 2 early and 8 late comlications. There are only 3 late complications in the Hook plate group, but with no significant statistical difference (p = 0.19; t = -1.34; df = 27). With respect to the subjective patient satisfaction following the treatment, the Hook plate group gave significantly better evaluations (4.4 +/- 0.19) (p = 0.007; t = 2.95; df = 27). Constant score showed no significant statistical difference (p = 0.078; t = 1.8; df = 27). The Hook plate group had a better median score (90 +/- 0.18) with respect to the Zugg-Bosw group (85 +/- 0.40).

The Hook plate method achieved somewhat better results, which indicate that this method is one of the ways to ensure a strong, stable fixation of the AC joint without transfixation. At the same time, this method does not inhibit the ligament healing and allows an early mobilisation.