title: Post-operative outcomes and complications of suspensory loop fixation device versus hook plate in acute unstable acromioclavicular joint dislocation: a systematic review and meta-analysis.
abstract: BACKGROUND
  Treatment of acute (≤3 weeks) acromioclavicular joint dislocation type III-VI is still controversial. Currently, the two modern techniques that are widely used are hook plate (HP) fixation and coracoclavicular ligament fixation using a suspensory loop device that consists of either a tightrope (single or double), endo-button (single or double), or synthetic ligament and absorbable polydioxansulfate sling.
  
  
  METHODS
  This systematic review was conducted according to the PRISMA guidelines. Relevant studies that reported Constant-Murley score (CMS), Pain Visual Analog score (VAS) and postoperative complications of either technique were identified from Medline and Scopus from inception to 5 October 2015.
  
  
  RESULTS
  Sixteen studies were included for the analysis of HP fixation, and 25 studies were included for analysis of loop suspensory fixation (LSF). Pooling of mean CMS and VAS scores gave 90.35 (95% CI 87.16, 93.54), 1.51 (95% CI 0.73, 2) in the HP group, and 92.48 (95% CI 90.91, 94.05), 0.32 (95% CI 0, 0.64) in the suspensory loop devices group, respectively. The pooled unstandardized mean differences (UMD) scores of CMS and VAS in LSF were 2.13 (95% CI -1.43, 5.69) and -1.19 (95% CI -2.03, -0.35) when compared to hook plating. The pooled prevalence of LSF and hook plating were 0.08 (95% CI 0.06, 0.10) and 0.05 (95% CI 0.02, 0.08) scores. The chance of having complications in the LSF group was 1.69 (95% CI 1.07, 2.60), which was statistically significantly higher than in the HP group.
  
  
  CONCLUSIONS
  LSF have higher shoulder function scores (CMS) and lower postoperative pain when compared to HP fixation; however, there are higher complication rates with LSF when compared to hook plating.
  
  
  METHODS
  IV.
authors.affiliation: Orthopedics Department, Police General Hospital, Bangkok, Thailand.
authors.forename: Alisara
authors.initials: A
authors.lastname: Arirachakaran
authors.affiliation: Orthopedics Department, Srinakarin Hospital, Khonkan, Thailand.
authors.forename: Manusak
authors.initials: M
authors.lastname: Boonard
authors.affiliation: Orthopedics Department, Police General Hospital, Bangkok, Thailand.
authors.forename: Peerapong
authors.initials: P
authors.lastname: Piyapittayanun
authors.affiliation: Orthopedic Department, Lerdsin General Hospital, Bangkok, Thailand.
authors.forename: Wichan
authors.initials: W
authors.lastname: Kanchanatawan
authors.affiliation: Orthopedics Department, College of Sports Science and Technology, Mahidol University, Bangkok, Thailand.
authors.forename: Kornkit
authors.initials: K
authors.lastname: Chaijenkij
authors.affiliation: Orthopedic Department, Aek Udon International Hospital, Udontani, Thailand.
authors.forename: Akom
authors.initials: A
authors.lastname: Prommahachai
authors.affiliation: Sport and orthopedic center, Samitivej Hospital, Bangkok, Thailand. Jatupon_kong@hotmail.com.
authors.forename: Jatupon
authors.initials: J
authors.lastname: Kongtharvonskul
mesh_terms: D000173:Acromioclavicular Joint / Q000293:injuries / Q000601:surgery*; D001860:Bone Plates; D006801:Humans; D016268:Internal Fixators; D004204:Joint Dislocations / Q000601:surgery*; D007593:Joint Instability / Q000601:surgery*; D008023:Ligaments, Articular / Q000601:surgery; D019637:Orthopedic Procedures / Q000009:adverse effects / Q000295:instrumentation*; D053441:Suture Anchors
keywords: AC injury; Endobutton; Hook plate; Loop suspensory fixation; Systematic review; Tightrope