Abstract | March 15, 2023

Complications following Hook Plate Fixation of the Acromioclavicular Joint: A Systematic Review

Ayobami Adeagbo, MS

Gabrielle E. Owusu-Ansah, MS, MBA, 4th Year Medical Student, Tulane University School of Medicine, 1430 Tulane Avenue, New Orleans; Ayobami T. Adeagbo, MS, 3rd Year Medical Student, Tulane University School of Medicine, 1430 Tulane Avenue, New Orleans; Victoria K. Ierulli, MS, Research Assistant, Tulane University School of Medicine, 1430 Tulane Avenue, New Orleans; Mary K. Mulcahey, MD, Assistant Program Director, Orthopaedic Surgery, Tulane University School of Medicine, 1430 Tulane Avenue, New Orleans

Learning Objectives

  1. o assess if hook plate fixation is an ideal technique for surgical repair of acromioclavicular joint dislocation.
  2. To examine the complications that can be expected with surgical intervention for acromioclavicular joint dislocation.

Introduction: Acromioclavicular (AC) joint injuries commonly occur due to direct physical trauma to the lateral aspect of the shoulder. Several surgical techniques can be used to reconstruct the AC joint including hook plate, allograft, suture-button construct, Kirschner-wires, and the Bosworth screw. Numerous studies have reported complications following various techniques for AC joint reconstruction which differ due to the different types of equipment used. The purpose of this study was to perform a systematic review of the literature to determine common complications following hook plate fixation of AC joint. Methods: A systematic review was performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. PubMed, Embase, Cochrane Library and Web of Science were searched for studies that were peer-reviewed publications in English, from 2000 to present that discussed methods of AC joint reconstruction. Studies conducted in the United States or countries that offer the same surgical intervention options were included. Studies were excluded if they were not a peer-reviewed study.

Results: 395 articles were initially identified, and 33 articles (2,455 patients) were selected for quality assessment and data extraction. The most common complications following hook plate fixation of the AC joint were subacromial osteolysis (14 studies), loss of fixation (12 studies), and infection (15 studies). Most of these complications improved after the plate was removed. In a study of 16 patients, they all (100%) experienced some type of discomfort with 6 patients (38%) experiencing impaired abduction. These symptoms were relieved after removal of the hook plate. Conclusion: Hook plate fixation of the AC joint provides good functional and radiographic outcomes for patients. Even so, subacromial osteolysis, subacromial impingement, implant irritation, and infection are complications that can arise at higher rates than other reconstructive techniques for AC repair. Hook plate fixation augmented with reinforcement such as coracoclavicular ligament tape or loop suspensory reconstruction may help lower rates of subacromial osteolysis as well as improve short-term functional outcome measures postoperatively. Orthopaedic surgeons can utilize this data to select best treatments for AC joint repair, but further research is needed to determine which is superior.



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