The Surgical Treatment of Acromioclavicular Dislocation with Tight-Rope®: Long-Term Clinical and Radiographic Results in 78 patients

Introduction Acromioclavicular dislocations account for 9% of all dislocations. Although numerous treatment techniques have been described, there is still no universally recognized gold standard. Stabilization with Tight-Rope® (TR) represents one of the most effective methods for restoring the normal alignment of the AC joint, ensuring early mobilization and good functional outcomes. Purpose of this study is to review our results using TR to treat high-grade acromioclavicular dislocations, analyzing complications, functional and radiological results. Materials and Methods This is a retrospective analysis of patients treated with Tight-Rope® between August 2016 and June 2024 for high-grade acromioclavicular dislocation. In 42 cases, only TR stabilization was performed, while in 36 cases, a K-wire was used to enhance stability. Clinical and radiographic evaluations were conducted during outpatient visits. No patients were lost to follow-up. Every kind of complication was assessed. Radiographic results were assessed by measuring Coracoid-Clavicle Distance (CCD) on the X-Rays between the last follow-up and the postoperative control. To evaluate functional outcomes, two scores were used: the ASES and the Constant-Murley Score. Results Seventy-eight patients with an average age of 41 years (range, 17 –75 y) were evaluated. There were a total of 46 Rockwood III, 10 Rockwood IV, and 22 Rockwood V dislocations. At an average follow-up of 48,72 months (range, 6- 98 m), two cases (2.5%) of reduction loss occurred, associated with functional limitation and pain, leading to reoperation. In seven patients, the reduction loss exceeded 25% but no further treatments were necessary. Functional results were excellent in most cases (97,4%), with mean CSS of 90 (min 55 – max 100), CSn and CSi of 96%, ASES score of 96 (range, 65 – 100). Discussion In patients treated with this technique, the initial dislocation grade does not seem to affect clinical results. Reduction loss was very limited with system settling in most cases. According to this study, reduction loss over time seems to result in a worse clinical outcome. The use of a K-wire is useless to increase the stability and guarantee the same results as the traditional technique Conclusions The treatment of acromioclavicular dislocations with Tight-Rope® represents a valid option based on excellent clinical, functional, radiographic results, and a low incidence of complications.