Comparison of Open vs. Mini-Open Approach in Treatment of Acute Acromioclavicular Joint Dislocation Using a...

Background/Objectives: Acromioclavicular (AC) joint dislocation is a common injury in young, active individuals, typically resulting from a direct shoulder impact. Treatment is guided by the Rockwood classification, with type III and higher injuries often managed surgically. Suspensory fixation systems are widely used, most commonly via a mini-open approach without direct visualization of the coracoid. This study compared clinical and radiological outcomes of open versus mini-open suspensory fixation in acute AC joint dislocation. Methods: This retrospective cohort study included patients treated surgically for Rockwood type III or higher AC joint dislocation between 2015 and 2021. Functional outcomes were assessed using Constant-Murley, ASES, and DASH scores. Pain, range of motion, and coracoclavicular (CC) distance were evaluated postoperatively and at final follow-up, including percentage difference compared with the contralateral side. Redislocation was defined as a ≥50% increase in CC distance (CCD). Complications, including cut-out, reoperations, and CC calcifications, were recorded. Results: Fifty-seven patients were included (mini-open n = 32, open n = 25; 52 men, 5 women). Mean age was 38.1 ± 13 years, with mean follow-up of 6.7 ± 1.5 years. The mini-open group had greater follow-up (90.1 [83.7-95.1]) than the open group (62.2 [60.3-75.4]). The mini-open group showed a significantly greater CCD at final follow-up (median [IQR] 14.7 [11.4-17.4] mm) compared with the open group (9.2 [7.8-11.1] mm). Redislocation occurred in 47% of mini-open versus 8% of open cases (p < 0.01). Functional scores, pain, and complication rates were similar between groups. Conclusions: Open suspensory fixation is associated with superior radiographic stability and lower redislocation rates compared to the mini-open approach, with comparable functional outcomes.