Comparative Evaluation of Functional Outcomes and Postoperative Complications After Minimally Invasive Fixation for...

Acromioclavicular (AC) joint dislocation is associated with severe pain, functional impairment, and postoperative complications. This study aimed to compare the efficacy and safety of TightRope with hook plate fixation for Rockwood type III injuries and to develop a postoperative complication prediction model.

This retrospective study enrolled 178 patients with acute Rockwood type III AC joint dislocation who underwent surgical treatment at Tongliao People's Hospital, China, between January 2020 and December 2023. Among them, 93 patients received arthroscopic TightRope fixation and 85 underwent conventional hook plate fixation. Perioperative parameters, radiographic outcomes, functional recovery, and complication rates were compared between the two groups. Linear regression was employed to identify factors influencing key recovery indicators, and a logistic regression model was constructed to predict complications.

The TightRope group exhibited significantly less intraoperative trauma, as indicated by reduced blood loss and shorter incision length (both p < 0.001). Postoperative infection was less frequent with TightRope (2.15% vs. 10.59%). At 6 months postoperatively, radiographic parameters-including coracoclavicular distance (CCD), acromioclavicular distance (ACD), and acromioclavicular index (ACI)-and functional outcomes (American Shoulder and Elbow Surgeons [ASES], Constant-Murley, and University of California, Los Angeles [UCLA] scores) demonstrated improvement in the TightRope group, along with lower visual analog scale (VAS) pain scores (all p < 0.05). Linear regression analysis identified operation type, intraoperative blood loss, and implant displacement as independent predictors of recovery. Logistic regression revealed TightRope as an independent protective factor for complications (odds ratio [OR] = 0.42, p = 0.028), whereas blood loss (OR = 1.86, p = 0.017) and ACD (OR = 1.34, p = 0.042) were independent risk factors. The prediction model showed good discrimination in the training set (area under the curve [AUC] = 0.84, 95% confidence interval [CI]: 0.76-0.92) and validation set (AUC = 0.76, 95% CI: 0.64-0.89), with satisfactory calibration (Hosmer-Lemeshow p = 0.177, p = 0.477) and clinical utility demonstrated by decision curve analysis.

Compared with hook plate fixation, the TightRope technique offers superior stabilization, improved functional recovery, and reduced complication rates in the management of acromioclavicular joint (ACJ) dislocations. The proposed predictive model provides a valuable tool for preoperative risk assessment and surgical decision-making.