No Significant Difference between Suture Button and Hook Plate in Treating Acute Rockwood Type III Acromioclavicular Joint Dislocation: A Systematic Review.

Abstract

Purpose: This study aims to systematically review the current evidence to compare the differences in outcomes of the suture button (SB) versus hook plate (HP) fixations for treating acute Rockwood type III acromioclavicular joint (ACJ) dislocation.

Methods: Two reviewers independently conducted a literature search based on the preferred reporting items from systematic reviews and meta-analyses guidelines. PubMed, EMBASE, Medline, and the Cochrane Library were systematically searched for studies comparing SB and HP in the treatment of acute Rockwood type III ACJ dislocation. Constant score, visual analogue scale (VAS), coracoclavicular distance, operation time, and occurrence of complications were assessed. Risk of bias was assessed using the Cochrane Collaboration's tools and the ROBINS-I tool.

Results: A total of 16 studies were included, consisting of two RCTs and 14 non-RCTs, with 471 patients in the SB group and 445 patients in the HP group. Among the included studies that reported patient-reported outcomes, four study indicated significantly higher Constant score in the SB group compared to the HP group, while the remaining five studies found no difference between the groups. Among the five included studies that reported VAS scores, two showed statistically significant differences favoring SB. Among 10 included studies reported operation time, three demonstrated shorter operation time for SB compared to HP, while two indicated longer operation time for SB surgery compared to HP. However, there was no statistically significant difference in the incidence rates of coracoclavicular distance and complications between the two groups.

Conclusions: The evidence suggests no clear clinical superiority of SB over HP in treating acute Rockwood type III ACJ dislocations. While some studies show SB may offer benefits like higher constant score and lower VAS scores, most outcomes reveal no significant differences.