In the evolution of acute acromioclavicular joint dislocation treatment, the clavicular hook plate has held significant importance. However, due to various complications such as clavicular hook fracture, acromial bone erosion and dissolution, subacromial impingement, and shoulder joint stiffness, it has gradually been replaced by the surgical approach of implementing TightRope for acromioclavicular joint reduction. Tightrope is applied in two modes for treating acromioclavicular joint dislocation: single-tunnel conoid ligament reconstruction and double-tunnel conoid ligament plus trapezoid ligament double-tunnel reconstruction. The prevailing opinion is that single-tunnel conoid ligament single-tunnel reconstruction may not effectively provide horizontal stability to the acromioclavicular joint, while double-tunnel conoid ligament and trapezoid ligament double-tunnel reconstruction align more closely with the physiological anatomy of the acromioclavicular joint, enabling the maximal restoration of both horizontal and vertical mechanical stability. However, there is also controversy surrounding this approach. Some studies suggest that when performing double-tunnel reconstruction of the coracoclavicular ligaments, the clavicular and coracoid tunnels may not be aligned vertically, potentially leading to suture tunnel abrasion and friction, which could result in late-stage loss of acromioclavicular joint reduction. Additionally, double tunnels increase the risk of clavicular fractures, and some argue that double-tunnel reconstruction may not offer clear advantages over single-tunnel reconstruction. Upon reviewing many cases where the clavicular hook plate was used to treat acromioclavicular joint dislocation, it was observed that deliberate repair of the coracoclavicular ligaments was not typically performed during clavicular hook plate application. Furthermore, very few instances of acromioclavicular joint re-dislocation occurred after removing the hook plate. In light of this, the academic community unanimously believes that acute acromioclavicular joint dislocation can naturally heal and repair the coracoclavicular ligaments after clavicular hook plate fixation. Given these findings, the question arises: why should we still perform double-tunnel coracoclavicular ligament reconstruction? Is it possible to treat acromioclavicular joint dislocation by adding clavicular joint fixation to single-tunnel conoid ligament reconstruction? This approach would simplify the surgical technique of double-tunnel reconstruction to avoid suture tunnel abrasion and clavicular fractures associated risks while simultaneously restoring horizontal stability to the acromioclavicular joint, theoretically aligning with the requirements of acromioclavicular joint dislocation treatment.

To compare and observe the clinical efficacy of two surgical methods, TightRope conoid ligament single-tunnel reconstruction combined with clavicular Kirschner wire fixation and TightRope conoid ligament single-tunnel reconstruction combined with suture anchor shoulder joint capsule repair in the treatment of acute acromioclavicular joint dislocation.

A retrospective analysis was conducted on 38 cases of Rockwood III and type V acute acromioclavicular joint dislocation treated between May 2018 and May 2022. In the control group, 18 cases underwent TightRope conoid ligament single-tunnel reconstruction combined with Clavicular Hook Pin fixation, while in the observation group, 20 cases underwent TightRope conoid ligament single-tunnel reconstruction combined with suture anchor shoulder joint capsule repair. Surgical operation time, postoperative complication rates, shoulder joint Constant-Murley functional scores, coracoclavicular distance, and acromioclavicular distance changes were compared between the two groups.

All 38 cases completed the follow-up. In the control group, there were 4 cases of loosening of Clavicular Hook Pins (including one case of pin dislocation), 2 cases of skin infection at the pinhole site, and 1 case of subluxation of the acromioclavicular joint detected at the 6-month follow-up, resulting in a complication rate of 38.89%. No similar occurrences were observed in the observation group. The surgical time in the control group was significantly shorter than in the observation group, with statistical significance. The Constant-Murley functional score of the shoulder joint in the control group was lower than that in the observation group at 1, 2, and 3 months postoperatively, with statistical significance. However, at 6 months postoperatively, there was no statistically significant difference in the Constant-Murley functional score between the two groups. In the control group, the coracoclavicular and acromioclavicular distances increased significantly at 6 months postoperatively compared to immediately after surgery, with statistical significance. There was no significant change in the observation group in the coracoclavicular distance and acromioclavicular distance at 6 months postoperatively compared to immediately after surgery, with no statistical significance. At 6 months postoperatively, the coracoclavicular distance and acromioclavicular distance in the control group were larger than those in the observation group, with statistical significance.

The application of TightRope conoid ligament single-tunnel reconstruction combined with clavicular Kirschner wire fixation or suture anchor shoulder joint capsule repair can achieve the goal of treating acute acromioclavicular joint dislocation. Additionally, supplementary suture anchor repair of the shoulder joint capsule results in a lower complication rate, early restoration of shoulder joint function, and better long-term postoperative outcomes than clavicular Kirschner wire fixation.