Abstract: BACKGROUND: Surgical management of acute Rockwood type III-V acromioclavicular joint dislocations remains controversial. While clavicular hook plate fixation is widely adopted, it carries risks of postoperative complications. The emerging arthroscopy-assisted loop titanium plate technique, despite its minimally invasive advantages, requires further validation regarding long-term efficacy and cost-effectiveness.
OBJECTIVE: To compare the clinical efficacy and cost-effectiveness of modified arthroscopic loop titanium plate fixation versus clavicular hook plate fixation for the treatment of acute Rockwood type III-V acromioclavicular joint dislocations.
METHODS: Eighty eligible patients with acute Rockwood type III-V acromioclavicular joint dislocations admitted at Zhongshan Hospital of Traditional Chinese Medicine Affiliated to Guangzhou University of Chinese Medicine between January 2021 and July 2024 were enrolled and randomly assigned to either the loop titanium plate group (n=40) or the hook plate group (n=40). Ultimately, 31 and 33 patients in each group completed follow-up, respectively. The loop titanium plate group underwent fixation using the FixButtonTM suspension system with 2.4 mm bone tunnel drilling, while the hook plate group received open reduction and internal fixation with a clavicular hook plate. Outcome measures included operative time, incision length, intraoperative blood loss, hospitalization costs, visual analogue scale score for pain, Constant-Murley Score, coracoclavicular distance, acromioclavicular distance, and complication rates, with a follow-up period of 6 months.
RESULTS AND CONCLUSION: (1) The loop titanium plate group had a longer operative time, shorter incision length, and less blood loss, but higher hospitalization costs (P < 0.05). (2) At 6 months postoperatively, the loop titanium plate group demonstrated a significantly higher excellent-good rate (94% vs. 82%; P < 0.05), lower visual analogue scale scores, higher Constant-Murley Score (P < 0.05), and better restoration of coracoclavicular and acromioclavicular distances (P < 0.05). (3) The total complication rate was lower in the loop titanium plate group (6% vs. 12%; P < 0.05). (4) It is concluded that although the modified arthroscopic loop titanium plate technique requires longer operative time and incurs higher costs, it can significantly reduce surgical trauma, alleviate pain, improve shoulder joint function, and lower the risk of complications. Its short-term clinical efficacy is superior. Despite the higher costs, the potential reduction in secondary surgeries may bring long-term economic benefits. It is more suitable for patients with high demands for incision aesthetics and functional recovery. Future studies with larger sample sizes and extended follow-up periods are warranted for further validation.

Key words:  acute acromioclavicular joint dislocation, arthroscopic, loop titanium plate, clavicular hook plate, clinical efficacy