Both Arthroscopically Assisted Suture Button and Hook Plate Are Effective in Treating Acute High-grade Acromioclavicular Joint Dislocation: A Systematic Review.

Purpose: To conduct a systematic review of clinical studies comparing the clinical outcomes of arthroscopically assisted suture button (AASB) and hook plate (HP) in the treatment of acute high-grade acromioclavicular joint (ACJ) dislocation to determine which technique provides superior clinical benefits.

Methods: Two independent researchers conducted literature searches based on Preferred Reporting Items from Systematic Reviews and Meta-analyses guidelines. PubMed, EMBASE, and the Cochrane Library were searched for studies comparing AASB and HP in treating acute high-grade (grade Ⅲ and above) ACJ dislocation. Inclusion criteria included clinical studies comparing AASB and HP for acute Rockwood Type ≥ III dislocations with evaluations of functional outcomes (Constant score (CS), pain score, American shoulder and elbow, Disabilities of the Arm, Shoulder and Hand). Studies were excluded if they were case reports, reviews, or had missing data, revision procedures, or loss to follow-up >20%. The methodological quality of the included studies was assessed based on Newcastle-Ottawa scale.

Results: In this systematic review, 14 studies with 782 participants were included, all of which were classified as level III-IV evidence. The analysis of 12 studies showed that the AASB group (81.9 to 95.31) had only slightly higher postoperative CS compared to the HP group (77.5 to 92.38), with nine studies reporting significant improvements, while three studies found no significant difference compared to the HP group. For pain outcomes, four studies showed lower pain score in the AASB group, while the rest found no significant difference; the VAS scores ranged from 0.3 to 3.61 in the AASB group and 0.5 to 4.9 in the HP group. Operation time was generally longer in the AASB group (AASB: 48.3 to 89.39 min; HP: 40.77 to 76.5 min). Complication rates were similar (AASB: 0% to 50%; HP: 0% to 36.36%), with only one study reporting a higher incidence in the AASB group. Minimal Clinically Important Difference analysis from three studies showed clinically significant improvements in CS with AASB, but no significant difference between AASB and HP for pain outcomes.

Conclusions: Despite longer operation times, AASB demonstrates comparable outcomes to HP for acute high-grade ACJ dislocations, with similar ranges in clinical scores and complication rates. Although AASB shows some advantages in functional outcomes, the differences between the two methods are minimal, suggesting that both approaches are effective and safe.