High vertical and horizontal stability at short term follow-up after an all-endoscopic double cerclage endobutton technique for acute acromioclavicular joint separations.

PURPOSE: The aim of this study was to evaluate the clinical and radiological outcomes in the treatment of acute acromioclavicular joint (ACJ) separations using an all-endoscopic double cerclage endobutton technique compared to an arthroscopic-assisted single bundle endobutton technique. The secondary aim was to analyze the complication, failure and revision rate of both procedures.

MATERIAL AND METHODS: All patients with acute ACJ separations Rockwood IIIB and V who were operated on using an all-endoscopic double-cerclage technique (2019-2022) or an arthroscopic-assisted single bundle technique (2017-2019) were included. The follow-up period was at least 12 months. Clinical and radiographic assessment was performed at follow-up. Complications, failures, and the revision rate were also investigated.

RESULTS: Twenty-eight patients (14 double cerclage group, 14 single bundle group, all male) with an average age of 37 (IQR: 15) years were available for follow-up after 45 (IQR: 38) months. The median time between trauma and surgery was 7 (IQR: 8) days. Very good clinical results without significant differences were observed in both groups (Constant score: 94 (IQR: 12) vs. 95 (IQR: 15), p=0.427, ACJ Instability score: 95 (IQR: 11) vs 87 (IQR: 22), p=0.210). All patients returned to sport, with an average sports level of 95% compared to the preoperative status. The single bundle group showed significantly increased anteroposterior instability (6 vs. 0, p=0.006). A total of 5 complications occurred (2 vs. 3), leading to 1 revision surgery in each group.

CONCLUSION: Excellent clinical results and high vertical and horizontal stability can be achieved with the all-endoscopic double cerclage technique. Horizontal instability occurred significantly more frequently with the single bundle technique. The prolonged operation time in the double cerclage group had no negative impact on postoperative outcomes, including complication and failure rates, and a learning curve to reduce this prolonged operative time should be considered.

LEVEL OF EVIDENCE: III, retrospective comparative clinical series.