title: Is AC TightRope fixation better than Bosworth screw fixation for minimally invasive operative treatment of Rockwood III AC joint injury?
abstract: BACKGROUND
  Injuries to the acromioclavicular (AC) joint are common in sports participants and may lead to instability or degenerative changes that require surgical intervention. Diagnostics include X-ray projections; MRI could also be a useful method. Surgical treatment of acute Rockwood type III AC dislocation varies on a case-by-case basis and includes coracoclavicular (CC) stabilisation with two techniques of minimal invasive fixation: the Bosworth screw and AC TightRope fixation (Arthrex, US). The aim of this study was to analyse whether there is a difference between these two surgical procedures in the quality of repair of CC ligaments by comparing preoperative and postoperative AC joint radiological and clinical findings.
  
  
  METHODS
  In this study, we evaluated our 5 years' experience of surgical management of Rockwood type III AC dislocation. Radiological analyses included measurement of CC distance at the AC joint, X-ray and MRI evaluation of CC ligament scar tissue continuity; clinical outcome was assessed using the Constant Murley, Oxford Shoulder and DASH scores preoperatively and during 6 months of postoperative follow-up.
  
  
  RESULTS
  A total of 68 patients with Rockwood type III AC dislocation were treated surgically with minimally invasive CC fixation using either the AC TightRope implant (34 patients, TR group) or the Bosworth screw (34 patients, BS group) in a prospective, randomised clinical trial. There was no statistically significant difference in radiological X-ray and MRI evaluations of postoperative results between the two groups of patients at the end of follow-up. Patients in the TR group reported significantly less inconvenience with treatment as the patients in the BS group had to undergo a second operation to remove the Bosworth screw. Postoperative recurrence of dislocation was observed in two patients in the TR group (5.88%) and in four patients in the BS group (11.76%) 6 months postoperatively. The difference between the two groups was not statistically significant (p=0.4).
  
  
  CONCLUSIONS
  MRI could be a useful method to evaluate quality of repair of CC ligaments. The minimally invasive surgical techniques used in this study showed similar radiological and clinical efficacy in the treatment of acute Rockwood type III AC dislocation, but AC TightRope fixation provided patients with significantly more treatment satisfaction and less inconvenience than Bosworth screw fixation.
authors.affiliation: University Clinic for Traumatology, Clinical Hospital Centre "Sisters of Charity", Zagreb, Croatia. Electronic address: darabos.dr@vz.t-com.hr.
authors.forename: N
authors.initials: N
authors.lastname: Darabos
authors.affiliation: Medical School, University of Zagreb, Zagreb, Croatia.
authors.forename: I
authors.initials: I
authors.lastname: Vlahovic
authors.affiliation: Department of Traumatology, Pula County Hospital, Pula, Croatia.
authors.forename: N
authors.initials: N
authors.lastname: Gusic
authors.affiliation: Scientific Unit, Varazdin County Hospital, Varazdin, Croatia.
authors.forename: A
authors.initials: A
authors.lastname: Darabos
authors.affiliation: Department of Traumatology, Karlovac County Hospital, Karlovac, Croatia.
authors.forename: B
authors.initials: B
authors.lastname: Bakota
authors.affiliation: University Clinic for Traumatology, Clinical Hospital Centre "Sisters of Charity", Zagreb, Croatia.
authors.forename: D
authors.initials: D
authors.lastname: Miklic
mesh_terms: D000173:Acromioclavicular Joint / Q000000981:diagnostic imaging* / Q000601:surgery; D000328:Adult; D017523:Croatia / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D005593:Fracture Fixation, Internal / Q000295:instrumentation / Q000379:methods; D006801:Humans; D016268:Internal Fixators; D004204:Joint Dislocations / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D008023:Ligaments, Articular / Q000601:surgery*; D008297:Male; D019060:Minimally Invasive Surgical Procedures / Q000295:instrumentation / Q000379:methods; D011184:Postoperative Period; D011446:Prospective Studies; D016896:Treatment Outcome
keywords: AC TightRope; AC dislocation; Bosworth screw; MRI; Rockwood III