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Purpose <p>The optimal surgical management of acute Rockwood type III acromioclavicular (AC) joint dislocations remains controversial. This study aimed to compare clinical and radiological outcomes among three techniques: hook plate (HP) fixation, isolated coracoclavicular (CC) suspension with a single endobutton, and combined AC and CC ligament reconstruction using two separate endobuttons.</p> Methods <p>This retrospective cohort study included 69 patients who underwent surgical treatment for acute Rockwood type III AC joint dislocations between 2018 and 2024 at the mean follow-up of approximately 24&#xa0;months. Patients were divided into three groups: hook plate fixation (Group A, <i>n</i> = 29), single endobutton CC fixation (Group B, <i>n</i> = 18), and combined AC and CC reconstruction with two separate endobuttons (Group C, <i>n</i> = 22). Clinical outcomes were assessed using the Constant–Murley Score (CMS), American Shoulder and Elbow Surgeons (ASES) score, Visual Analog Scale (VAS), and time to return to daily activities and sports. Radiological evaluation included acromioclavicular distance (ACD) and coracoclavicular distance (CCD).</p> Results <p>All groups demonstrated significant improvement (<i>p</i> &lt; 0.05) in CMS, ASES, and VAS scores from baseline to final follow-up, which refers to the last clinical and radiographic assessment at approximately 24&#xa0;months postoperatively. At the final assessment, Group C demonstrated more favorable outcomes, with significantly higher CMS and ASES scores and a lower VAS score compared to Groups A and B (<i>p</i> &lt; 0.05). Importantly, the observed improvements in all three scores exceeded the reported minimal clinically important difference thresholds across all groups.&#xa0;Radiologically, while CCD did not differ significantly among groups, ACD showed significant intergroup differences (<i>p</i> &lt; 0.05), with Group C demonstrating better maintenance of AC joint reduction. Group C also demonstrated a lower complication rate descriptively and the shortest time to return to daily activities and sports (<i>p</i> &lt; 0.05).</p> Conclusions <p>All three surgical techniques were effective in treating acute Rockwood type III AC joint dislocations. Combined AC–CC reconstruction with two endobuttons offered superior maintenance of AC joint reduction versus isolated CC suspension, a lower complication rate trend than hook plate fixation, and faster return to activities. Radiographic advantages over hook plate fixation were not statistically significant, and CCD differences were non-significant across groups.</p>

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Combined AC and CC ligament reconstruction with two separate Endobuttons: optimizing clinical and radiological results in acute Rockwood III AC joint dislocations

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年6月22日

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  • Nimra Ghafar Shah,
  • Yinyin Wang,
  • Wenjing Chen,
  • Zhida Shen,
  • Min Zhou,
  • Kai Deng,
  • Linglong Deng,
  • Li Yu

摘要

Purpose

The optimal surgical management of acute Rockwood type III acromioclavicular (AC) joint dislocations remains controversial. This study aimed to compare clinical and radiological outcomes among three techniques: hook plate (HP) fixation, isolated coracoclavicular (CC) suspension with a single endobutton, and combined AC and CC ligament reconstruction using two separate endobuttons.

Methods

This retrospective cohort study included 69 patients who underwent surgical treatment for acute Rockwood type III AC joint dislocations between 2018 and 2024 at the mean follow-up of approximately 24 months. Patients were divided into three groups: hook plate fixation (Group A, n = 29), single endobutton CC fixation (Group B, n = 18), and combined AC and CC reconstruction with two separate endobuttons (Group C, n = 22). Clinical outcomes were assessed using the Constant–Murley Score (CMS), American Shoulder and Elbow Surgeons (ASES) score, Visual Analog Scale (VAS), and time to return to daily activities and sports. Radiological evaluation included acromioclavicular distance (ACD) and coracoclavicular distance (CCD).

Results

All groups demonstrated significant improvement (p < 0.05) in CMS, ASES, and VAS scores from baseline to final follow-up, which refers to the last clinical and radiographic assessment at approximately 24 months postoperatively. At the final assessment, Group C demonstrated more favorable outcomes, with significantly higher CMS and ASES scores and a lower VAS score compared to Groups A and B (p < 0.05). Importantly, the observed improvements in all three scores exceeded the reported minimal clinically important difference thresholds across all groups. Radiologically, while CCD did not differ significantly among groups, ACD showed significant intergroup differences (p < 0.05), with Group C demonstrating better maintenance of AC joint reduction. Group C also demonstrated a lower complication rate descriptively and the shortest time to return to daily activities and sports (p < 0.05).

Conclusions

All three surgical techniques were effective in treating acute Rockwood type III AC joint dislocations. Combined AC–CC reconstruction with two endobuttons offered superior maintenance of AC joint reduction versus isolated CC suspension, a lower complication rate trend than hook plate fixation, and faster return to activities. Radiographic advantages over hook plate fixation were not statistically significant, and CCD differences were non-significant across groups.