Abstract:
INTRODUCTION : The purpose of this study was to perform a systematic review and meta-analysis of both randomized controlled
and observational studies comparing double-button suture fixation to hook plate fixation for types III–IV acromioclavicular
joint dislocation.
METHODS : Systematic review of Medline, Embase, Scopus, and Google Scholar, including all levels 1–3 studies from 2000
to 2022. Clinical outcome scores, range of motion, and complications were included. Risk of bias was assessed using the
Cochrane Collaboration’s ROB2 tool and ROBINs-I tool. MINORS and modified Coleman Methodology Score (CMS)
were used to assess within study quality. The GRADE system was used to assess the overall quality of the body of evidence.
Heterogeneity was assessed using χ2 and I2 statistics.
RESULTS : Fifteen studies were included. Three of the four included LOE II and eleven of the LOE III studies had a high risk
of bias. Study quality was considered poor and fair for 67% by MINORS criteria and 93% for CMS criteria. The pooled
estimate (SMD 0.662) for all clinical outcomes was statistically significant and in favor of button repair (p = 0.0001). The
pooled estimate (SMD 0.662) for all VAS pain scores was statistically significant, again in favor of button repair (p = 0.001).
CONCLUSIONS : The results of this meta-analysis demonstrated significantly better outcomes of button repair for acute ACJ
dislocations when compared to clavicle hook plate. Button repair is also associated with a 2.2 times lower risk for complications.
However, risk of bias is high, and study quality within and between studies was low. These results, therefore, must be
viewed with caution.
