Tightrope vs. hook plate fixation for acute acromioclavicular joint dislocation: a systematic review and
Brandon Lim1, Ariel Chai1, Samher Jassim2
1Department of General Surgery, Sengkang General Hospital, Singapore, Singapore.
JSES Reviews, Reports, and Techniques
|July 23, 2025
Summary
The clavicular hook plate (HP) offers better Constant-Murley scores and less blood loss for ACJ dislocations compared to the TightRope (TR). However, TR fixation shows improved visual analog scale scores and reduced coracoclavicular distance post-surgery.
Area of Science:
- Orthopedic Surgery
- Sports Medicine
- Biomechanical Engineering
Background:
- Acromioclavicular joint (ACJ) dislocations require operative treatment to restore joint congruity and stability.
- Optimal surgical techniques for ACJ dislocations remain debated, necessitating comparative analysis.
- This study systematically reviews and meta-analyzes clavicular hook plate (HP) versus TightRope (TR) fixation for ACJ dislocations.
Purpose of the Study:
- To compare the efficacy and safety of clavicular hook plate (HP) versus TightRope (TR) fixation in managing acromioclavicular joint (ACJ) dislocations.
- To evaluate key outcomes including operative time, blood loss, clinical scores, coracoclavicular distance, and complication rates.
Main Methods:
- A systematic literature search was performed across Embase, Scopus, PubMed, and Web of Science.
- Included studies were assessed for methodological quality using the Methodological Index for Nonrandomized Studies and Cochrane Risk of Bias 2 tools.
- Meta-analysis compared outcomes between HP and TR groups, including operative time, blood loss, Constant-Murley scores, visual analog scale scores, coracoclavicular distance, and complications.
Main Results:
- The meta-analysis included 12 studies with 683 patients (371 HP, 312 TR).
- Clavicular hook plate (HP) fixation demonstrated superior Constant-Murley scores and reduced intraoperative blood loss compared to TightRope (TR).
- TightRope (TR) fixation resulted in better visual analog scale scores and shorter postoperative coracoclavicular distance (CCD).
Conclusions:
- Both HP and TR fixation show comparable operative times, complication rates, and functional shoulder scores (UCLA, ASES).
- HP fixation is associated with less intraoperative bleeding and better long-term functional scores (Constant-Murley), while TR offers better immediate pain relief (VAS) and joint alignment (CCD).
- Further high-quality randomized controlled trials are recommended to enhance the evidence base for ACJ dislocation management.
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