Abstract:

Background

Acromioclavicular dislocation is a common shoulder injury in orthopedics.The surgical treatment of acromioclavicular dislocation is varied and controversial. In past clinical practice，rigid fixation schemes， such as clavicular hook plate surgery， were mainly used， but with the deepening of people's understanding of acromioclavicular joints， elastic fixation schemes have gradually been recognized by people. A double-Endobutton plate in an elastic fixation scheme has become the primary surgical method for treating acromioclavicular dislocation. However， some scholars believe that double-Endobutton plate surgery only focuses on the reconstruction of the coracoclavicular ligament， ignoring the repair of the acromioclavicular ligament， resulting in an increase in the incidence of postoperative complications such as shoulder instability. Therefore， exploring the excellent clinical effect of different surgical methods in treating acromioclavicular dislocation has become one of the current research hotspots.

Objective

To evaluate the efficacy of different methods in treating acromioclavicular dislocation and to discuss the necessity of repairing the acromioclavicular ligament in treating acromioclavicular dislocation with the double-Endobutton plate.

Methods

PubMed， Embase， Cochrane Library， CNKI， WF， VIP， and Sinomed were searched for published Chinese and English literature at home and abroad， and the literature was screened according to inclusion and exclusion criteria. The retrieval period was from May 15， 2024. The mesh metaanalysis was performed using RevMan 5.3 and Stata 16 software.

Results

A total of 24 pieces of literature were included， including 11 randomized controlled trials and 13 case-control studies involving 1 496 patients. The results of mesh meta-analysis showed that compared with CHP， both double-Endobutton and double-Endobutton combined with acromioclavicular ligament repair could reduce the incidence of postoperative complications， enhance postoperative shoulder joint function， and improve postoperative pain， and the differences were statistically significant. The cumulative probability ranking results showed that：operation time：CHP ＞ double-Endobutton ＞ double-Endobutton combined with acromioclavicular ligament repair； Intraoperative blood loss：double-Endobutton ＞ CHP ＞ double-Endobutton combined with acromioclavicular ligament repair； Postoperative complication rate， CM score， and Karlsson score were as follows：double Endobutton combined with acromioclavicular ligament repair ＞ double Endobutton ＞CHP； VAS score：double-Endobutton ＞ double-Endobutton combined acromioclavicular ligament repair ＞CHP.

Conclusion

Overall， double-Endobutton alone and its combination with acromioclavicular ligament repair are superior to CHP surgery in reducing postoperative complication rates， improving postoperative shoulder joint function， and alleviating postoperative pain. The reduction in postoperative complication rates is even more significant when using double-Endobutton in combination with ACJL repairs than when using it alone. Other outcome indicators show similar effects between these two procedures. However， more highquality， large-sample， and multi-center randomized controlled trials are still needed to confirm further the effectiveness of double-Endobutton in combination with ACJL repairs.

Key words: Acromioclavicular joint dislocation, Acromioclavicular ligament, Doubleendobutton, Clavicular hook plate, Network Meta-analysis