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Superior outcomes found with double double-button suture for acromioclavicular joint separation
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Patients with acute high-grade acromioclavicular joint separation treated with arthroscopically assisted double double-button suture had significantly superior outcomes in all clinical scores compared with patients treated with open reduction and a clavicular hook plate, according to published results.
Researchers randomly assigned 73 patients with acute high-grade acromioclavicular joint separation to be treated with open reduction and a clavicular hook plate or arthroscopically assisted double double-button suture within 14 days of injury. Researchers analyzed patients using clinical scores and acromioclavicular-specific radiographs preoperatively and at 6, 12 and 24 months postoperatively. Using the anchor-based method, researchers assessed minimal clinically important differences.
Researchers continuously followed 27 of 35 patients in the clavicular hook plate group and 29 of 38 patients in the double double-button suture group until the 24-month follow-up. Compared with preoperative status, results showed significantly increased scores after surgery in all patients. Researchers noted 18.52% and 6.89% of patients in the clavicular hook plate group and double double-button suture group, respectively, had persistent clinically assessed horizontal instability. At 24 months, both groups had equal loss of reduction according to relative coracoclavicular distance.
“The subanalysis of the high-grade injuries (Rockwood IV/V) revealed that these patients showed significant benefits from the [double double-button suture] dDBS produced in the clinical assessments,” the authors wrote. “The clavicular hook plate procedure resulted in good to excellent clinical outcome data too and displays an alternative procedure for patients with [a] need for less restrictive rehabilitation protocols.” – by Casey Tingle
Disclosures: Stein reports he receives payment from Arthrex for instructional courses. Please see the full study for a list of all other authors’ relevant financial disclosures.
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