Arthroscopic suspension fixation without coracoid bone tunnel for acute acromioclavicular joint dislocation

doi:10.3877/cma.j.issn.1674-134X.2026.01.013

Abstract

Abstract:

Objective

To investigate the clinical effect of a novel arthroscopic suspension fixation without coracoid bone tunnel in the treatment of acute acromioclavicular joint dislocation (ACJD).

Methods

A retrospective analysis was carrideout on the clinical data of patients who underwent arthroscopic suspension fixation without coracoid bone tunnel for ACJD treatment at Jiangning Hospital affiliated with Nanjing Medical University during January 2022 to December 2024 were included. Clinical data collected included age, sex, Rockwood classification, operative time, pre- and postoperative visual analog scale (VAS) pain scores on the first postoperative day, and Constant-Murley shoulder scores at six months after surgery. The size of the coracoclavicular interval was measured through X rays before surgery, one day, one and six months after surgery to monitor any loss of reduction.Paired non-parametric tests, paired t tests, and one-way repeated-measures analysis of variance were used separately to compare preoperative and postoperative VAS scores, shoulder joint scores, and changes in the coracoclavicular interval.

Results

A total of 21 patients with ACJD were included, all treated with arthroscopic suspension fixation without coracoid bone tunneltechnique. Among them, there were 11 males and 10 females, with a median age of 39 years. The average duration from injury to surgery was (2.8±1.0) d, and the mean surgical duration was (118±11) min. Postoperative VAS scores significantly decreased (Z=-230.0, P<0.001). The Constant-Murley score also significantly improved (t=30.90, P<0.001). The coracoclavicular distances before surgery,one day, one and six months after surgery were (24.0±4.1) mm, (5.2±1.0) mm, (5.6±1.1) mm, and (5.7±1.1) mm, respectively. The differences of coracoclavicular intervals among the time points of before surgery, one day, one month and six months after surgery were statistically significant (corrected F=467.10, P<0.001). The coracoclavicular intervals at one day, one month, and six months after surgery were significantly smaller than the preoperative values (all P<0.001), while there was no significant difference in the coracoclavicular distance between one day, one and six months after surgery (all P>0.05).

Conclusion

Arthroscopic suspension fixation without coracoid bone tunnel for ACJD can relieve shoulder joint pain, maintain shoulder joint function, and achieve satisfactory clinical efficacy.

Key words: Acromioclavicular joint, Joint dislocations, Arthroscopy, Coracoid process

Ya Xu, Xiang Wang, Gaopeng Liu, Yuru Huang, Bin Wang. Arthroscopic suspension fixation without coracoid bone tunnel for acute acromioclavicular joint dislocation[J]. Chinese Journal of Joint Surgery(Electronic Edition), 2026, 20(01): 104-109.

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URL: https://zhgjwkzz.cma-cmc.com.cn/EN/10.3877/cma.j.issn.1674-134X.2026.01.013

https://zhgjwkzz.cma-cmc.com.cn/EN/Y2026/V20/I01/104

Figures/Tables 4

Figure 1 Surgical approach and anatomical exposure. A is the surgical approach, including the posterior approach (red P) for arthroscope insertion, the anterior approach (red A) for exposure of the coracoid base, and a two centimetres incision at the distal clavicle; B is arthroscopic exposure of the coracoid process; C is ACL（anterior cruciate ligament） guide for creation of the clavicular bone tunnel

Figure 2 Surgical procedure of arthroscopic suspension fixation without coracoid bone tunnel. A shows grasping the tail ends of two pre-placed PDS（polydioxanone suture） via the anterior approach；B shows grasping the two PDS sutures out of the body and tying them to form a continuous traction suture；C is creation of the clavicular bone tunnel；D shows fixation of the loop and titanium plate with 5-0 non-absorbable suture (indicated by the black arrow)；E shows adjusting the loop with a probe under arthroscopic visualization to prevent soft tissue entrapment between the inferior border of the coracoid process and the loop；F is intraoperative fluoroscopy showing satisfactory joint reduction；G is surgical suture site；H is schematic diagram of surgical outcome

Table 1 Comparative analysis of preoperative and postoperative indicators in ACJD patients (n=21)

时间Time	VAS[M（P₂₅，P₇₅）]	Constant-Murley评分（±s）	喙锁间隙[mm，（±s）]Coracoclavicular distance
术前Before operation	5.0（4.0，6.5）	52.0±5.6	24.0±4.1
术后第1天One day after operation	0（0，1.0）	-	5.2±1.0
术后1个月One month after operation	-	-	5.6±1.1
术后6个月Six months after operation	-	93.0±4.6	5.7±1.1
统计值Statistical values	Z=-230.00	t=30.90	F=467.10
P值	<0.001	<0.001	<0.001

Figure 3 Pre-and postoperative images of acute right ACJD （acromioclavicular joint dislocation) treated with arthroscopic suspension fixation without coracoid bone tunnel. A is X-ray image at anteroposterior view of right shoulder before surgery, showing Rockwood typeⅢ acromioclavicular joint dislocation；B is X-ray image at anteroposterior view of right shoulder one day after surgery, showing satisfactory reduction of the acromioclavicular joint；C is CT image of right shoulder one month after surgery, showing satisfactory anteroposterior reduction of the acromioclavicular joint；D is X-ray image at anteroposterior view of right shoulder six months after surgery, showing the acromioclavicular joint remained in position

References 15

[1]	Kani KK, Porrino JA, Mulcahy H, et al. Surgical techniques for management of acromioclavicular joint separations: review and update for radiologists[J]. Skeletal Radiol, 2020, 49（8）: 1195-1206.
[2]	Frank RM, Cotter EJ, Leroux TS, et al. Acromioclavicular joint injuries: evidence-based treatment[J]. J Am Acad Orthop Surg, 2019, 27（17）: e775-e788.
[3]	Yu P, Zhang Y, Ye T, et al. Clinical and radiological outcomes of acute Rookwood type IIIB acromioclavicular joint dislocation: Mini-open tightrope technique versus hook plate[J]. Injury, 2023, 54（Suppl 2）: S63-S69.
[4]	Wang C, Meng JH, Zhang YW, et al. Suture button versus hook plate for acute unstable acromioclavicular joint dislocation: a meta-analysis[J]. Am J Sports Med, 2020, 48（4）: 1023-1030.
[5]	Gowd AK, Liu JN, Cabarcas BC, et al. Current concepts in the operative management of acromioclavicular dislocations: a systematic review and meta-analysis of operative techniques[J]. Am J Sports Med, 2019, 47（11）: 2745-2758.
[6]	刘瀚忠, 隋文渊, 翟丽芹, 等. 锁骨钩钢板与Endobutton带襻钢板治疗肩锁关节脱位的疗效比较[J]. 中华创伤骨科杂志, 2019, 21（8）: 710-713.
[7]	Jeong JY, Chun YM. Treatment of acute high-grade acromioclavicular joint dislocation[J]. Clin Shoulder Elb, 2020, 23（3）: 159-165.
[8]	Liu Y, Zhang X, Yu Y, et al. Suture augmentation of acromioclavicular and coracoclavicular ligament reconstruction for acute acromioclavicular dislocation[J/OL]. Medicine, 2021, 100（33）: e27007. DOI:10.1097/md.0000000000027007.
[9]	朱圣旺, 覃志, 韦钧译, 等. 关节镜下双带襻钢板技术治疗肩锁关节脱位[J/OL].中华关节外科杂志（电子版）, 2022, 16（1）: 99-103.
[10]	Chen RE, Gates ST, Vaughan A, et al. Complications after operative treatment of high-grade acromioclavicular injuries[J]. J Shoulder Elbow Surg, 2023, 32（9）: 1972-1980.
[11]	Gosselin MM, Denney BS, Gregory JM. Treatment of acromioclavicular joint instability with a tunnel-free reconstruction technique[J]. Arthrosc Tech, 2022, 11（5）: e895-e901.
[12]	Choi NH, Lim SM, Lee SY, et al. Loss of reduction and complications of coracoclavicular ligament reconstruction with autogenous tendon graft in acute acromioclavicular dislocations[J]. J Shoulder Elbow Surg, 2017, 26（4）: 692-698.
[13]	Li F, Li Y, Lu Y, et al. Clinical outcome of a modified coracoid tunnel-free coracoclavicular sling technique with remnant preservation for the treatment of high-grade acromioclavicular joint separation: a report of 48 cases with 2 to 5 years of follow-up[J]. Am J Sports Med, 2021, 49（6）: 1612-1618.
[14]	薛骋, 宋李军, 张鸣, 等. 喙锁韧带附着区域的定量解剖学研究[J]. 中华创伤骨科杂志, 2023, 25（11）: 986-992.
[15]	Patted SM, Kumar A, Halawar RS. Morphometric analysis of clavicle and its medullary canal: a computed tomographic study[J]. Indian J Orthop, 2020, 54（Suppl 2）: 283-291.

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