title: Operative treatment of acute acromioclavicular joint injuries graded Rockwood III and IV: risks and benefits in tight rope technique vs. k-wire fixation.
abstract: BACKGROUND
  Operative treatment of acromioclavicular joint injuries is recommended for higher degree dislocations. Recently a new option has become available with the minimally-invasive tight rope technique. Whereas clinical studies justify the medical use, risks and benefits remain unclear. Therefore, this study analyzed these facts associated with this procedure and compared them to K-wire fixation.
  
  
  METHODS
  A retrospective analysis was performed of patients surgically treated either with the TightRope™-technique (TR) or K-wires (KW) for a first event isolated Rockwood type III or higher acromioclavicular joint dislocation between 2004 and 2011. Timing for surgery, surgical duration, length of hospital stay, costs, complications and outpatient visits were recorded.
  
  
  RESULTS
  41 patients were included (TR: n = 18; KW: n = 23) with comparable demographics and injury severity. A trend towards shorter operation time was seen in the TR group (TR: 64.3 ±19.8 min. vs. KW: 80.9 ±33.7 min., n.s.) A tendency for lower total operation theater costs was seen in the TR group (TR: 474 ±436.5€ vs. KW: 749.1 ±31.2€, n.s.). Patients from the TR group left hospital earlier (TR: 2 ±1d vs. KW: 3.6 ±1.8d, p = 0.002). Severe complications (i.e. a fracture of the clavicle or nerve damage) occurred in neither of the groups. Early loss of reduction (n = 1) and impaired wound healing (n = 2) was seen in the TR group. Migrating K-wires (n = 4), loss of reduction (n = 1) and impingement syndrome (n = 1) were recorded in the KW group.
  
  
  CONCLUSIONS
  Usage of the tight rope technique offered advantages, such as being a safe minimally-invasive technique and showed a tendency towards shorter operation time, and lower physician- and total operation and theater costs. Material costs were significantly higher for this device but patients were discharged earlier. The influence of different clinical long-term results on the financial outcome needs to be evaluated in further studies.
authors.affiliation: Department of Orthopedic Trauma Surgery, University Hospital RWTH Aachen, Paulwelsstreet 30, Aachen, 52074, Germany.
authors.forename: Klemens
authors.initials: K
authors.lastname: Horst
authors.affiliation: Department of Orthopedic Trauma Surgery, University Hospital RWTH Aachen, Paulwelsstreet 30, Aachen, 52074, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Dienstknecht
authors.affiliation: Department of Orthopedic Trauma Surgery, University Hospital RWTH Aachen, Paulwelsstreet 30, Aachen, 52074, Germany.
authors.forename: Miguel
authors.initials: M
authors.lastname: Pishnamaz
authors.affiliation: Department of Orthopedic Trauma Surgery, University Hospital RWTH Aachen, Paulwelsstreet 30, Aachen, 52074, Germany.
authors.forename: Richard Martin
authors.initials: RM
authors.lastname: Sellei
authors.affiliation: Department of Orthopedic Trauma Surgery, University Hospital RWTH Aachen, Paulwelsstreet 30, Aachen, 52074, Germany.
authors.forename: Philipp
authors.initials: P
authors.lastname: Kobbe
authors.affiliation: Department of Orthopedic Trauma Surgery, University Hospital RWTH Aachen, Paulwelsstreet 30, Aachen, 52074, Germany.
authors.forename: Hans-Christoph
authors.initials: HC
authors.lastname: Pape
keywords: Acromioclavicular joint dislocation; Analysis; Comparison; Costs; K-wires; Reconstruction; Surgery; Tight rope technique