Treatment Of Type Ⅲ And Ⅳ Acromioclavicular Joint Dislocation With The Assistance Of Shoulder Arthroscopy

Objective:To analyze and compare the short-term outcomes of arthroscopically assisted placement of a tightrope loop plate with incisionally placed a-c tightrope loop plate in patients with Rockwood type Ⅲ and Ⅳ acromioclavicular dislocation.Methods:We collected 57 patients with acromioclavicular dislocation of Rockwood types Ⅲ and Ⅳ from January 2017 to April 2019 at the Department of orthopedics and first Department of orthopedics,Chengde Central Hospital,in which 30 patients were collected in the Department of orthopedics,for whom a tightrope loop plate group was placed under arthroscopic assistance,hereafter referred to as the arthroscopy group,and 27patients were collected in the Department of orthopedics,for whom a-c was placed by incision Tightrope loop plate group,hereafter referred to as the incision group.Data collected from patients were retrospectively reviewed to compare incision length,duration of surgery,intraoperative blood loss,number of hospital days,VAS score and Constant score for the shoulders at 1,3,and 6 months after surgery,complication rate at the last follow-up,distance between the ipsilateral acromioclavicular joint and coracoclavicular space on the affected side at the last follow-up,and Klasson score at the last follow-up Graded rate of excellent,the analysis compared the short-term clinical outcomes of the two procedures.Results:Follow up beyond 6 months was available for all 57 patients and averaged 8.65±1.30 months（range 6-12 months）.The incision length,operation time,intraoperative blood loss and hospital stay in the arthroscopy group were less than those in the incision group,（p<0.05）.There was a significant difference in VAS score between the two groups(F_time×group=3.724,p=0.048).There was a significant difference in VAS score between the two groups at different time points(F_time=898.509,p<0.001).There was an interaction between the two groups and time(F_time×group=65.779,p<0.001),that is,the VAS scores between the two groups showed different trends over time,which was indicated by the simple effect test that the VAS scores of the two groups gradually decreased with the increase of time（p<0.05）.There was a difference in Constant score comparison between the two groups（Ftime=6.499,p=0.014）,a difference in Constant score comparison between the two groups at different time points(F_time=98317.651,p<0.001),and an interaction between the two groups and time(F_time×groups=289.457,p<0.001),i.e.the trend of Constant score change over time was different between the two groups,which was indicated by the simple effect test that constant score gradually increased in both groups as time increased（p<0.05）.There was no significant difference in the incidence of complications at the last follow-up between the two groups（p=0.062）,in the acromioclavicular joint space distance and coracoclavicular space distance on the affected side at the last follow-up between the two groups（p>0.05）,and in the rate of excellent Klasson score at the last follow-up between the two groups（p=0.394）.Conclusion:The arthroscopically assisted placement of a tightrope loop plate compared with the incisionally placed a-c tightrope loop plate in the treatment of acromioclavicular dislocation has the advantage of being less traumatic,allowing for faster early postoperative functional recovery of patients,and may simultaneously handle a combined injury within the shoulder joint,reducing the incidence of postoperative pain in patients.