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A comparison between two double-button endoscopically assisted surgical techniques for the treatment acute
P Vulliet1, M Le Hanneur2, V Cladiere3
1Department of Orthopedics and Traumatology - Service of Hand, Upper Limb and Peripheral Nerve Surgery - Assistance Publique - Hôpitaux de Paris, Georges Pompidou European Hospital (HEGP), Paris Descartes University, 20 Rue Leblanc, 75015, Paris, France. pierrevulliet@gmail.com.
Purpose:
To compare clinical and radiological outcomes between two endoscopically assisted double-button techniques in high-grade acute acromioclavicular separations.
Methods:
A retrospective single-center study was conducted in patients with acute acromioclavicular joint dislocation Rockwood types III and V, from 2009 to 2014. All were treated endoscopically, with a 1-year minimum follow-up. Two consecutive series were conducted; the first (TR group) received the TightRope® system, whereas last series (DB group) was treated with the Dog Bone® button technology (Arthrex, Naples, FL, USA). Primary endpoints were last follow-up values of Constant score (CS) and Quick-DASH (QD) score. Moreover, the posttraumatic displacement and its evolution were assessed on bilateral Zanca radiographs. A displacement of 5 mm or greater the day after surgery was considered as a lack of reduction; the same difference on last follow-up X-rays was considered as a loss of reduction.
Results:
Forty patients were reviewed: 22 in the TR group and 18 in the DB group. After a mean follow-up of 27.7 ± 8.3 months, CS and QD averaged, respectively, 94.3 ± 4.4 and 2.0 ± 2.6 in the TR series, whereas they averaged, respectively, 95 ± 6.1 and 3.4 ± 3.3 in the DB series after a mean follow-up of 24.1 ± 5 months (PCS = 0.16, PQDS = 0.08). Lack of reduction and loss of reduction rates were significantly higher in the DB group, with P = 0.0005 and P < 0.0001, respectively.
Conclusions:
Both techniques provided good to excellent functional outcomes. However, considering inferior radiological results using the Dog Bone® device, we would prefer the TightRope® device in acute acromioclavicular dislocations.
Level Of Evidence:
IV: Therapeutic study-cases series.
