Acromioclavicular (AC) joint injuries are among the most common shoulder girdle injuries and account for nearly 9–12% of all shoulder injuries encountered in orthopaedic practice.[1] These injuries are frequently seen in young active adults, athletes, and individuals involved in road traffic accidents or contact sports.[2] The acromioclavicular joint plays an important role in maintaining the normal biomechanics and coordinated movement of the shoulder complex. Disruption of this articulation can significantly impair upper limb function and quality of life.[3]

The mechanism of injury commonly involves direct trauma to the lateral aspect of the shoulder with the arm in adduction, resulting in varying degrees of ligamentous disruption.[4] The Rockwood classification remains the most widely accepted system for categorizing AC joint dislocations into six types based on the severity of soft tissue injury and displacement.[5] While type I and II injuries are generally managed conservatively, surgical intervention is usually indicated for type IV, V, and VI injuries and selected type III injuries in physically active patients.[6]

Numerous surgical techniques have been described for AC joint stabilization, including Kirschner wire fixation, hook plate fixation, Bosworth screw fixation, Weaver-Dunn procedure, tendon graft reconstruction, and arthroscopic suspensory fixation methods.[7] However, no single technique has emerged as the definitive gold standard due to varying complication rates and biomechanical limitations.[8]

Recently, double endobutton fixation combined with fibre wire reconstruction has gained increasing attention because it closely replicates the native coracoclavicular ligament anatomy and provides stable fixation with minimal soft tissue disruption.[9] The technique offers several advantages including smaller incision, reduced implant prominence, early mobilization, and avoidance of hardware removal surgery.[10]

Biomechanical studies have demonstrated that suspensory fixation systems provide superior load-to-failure characteristics and better maintenance of reduction compared to traditional fixation methods.[11] Furthermore, the use of fibre wire augmentation enhances construct stability and minimizes the risk of recurrent displacement.[12]

Despite increasing utilization of this technique, limited Indian studies have evaluated the clinical and functional outcomes following double endobutton and fibre wire reconstruction in AC joint dislocations. Therefore, the present study was conducted to assess postoperative functional recovery, pain relief, radiological maintenance of reduction, and complications associated with this surgical procedure.

Study Design Prospective observational study. Study Setting The present study was conducted in the Department of Orthopaedics at Shri Rawatpura Institute of Medical Sciences and Research, New Raipur. Study Duration January 2024 to June 2025. Sample Size Thirty patients diagnosed with acute AC joint dislocation were included in the study. Inclusion Criteria • Patients aged between 18 and 60 years • Acute AC joint dislocation less than 3 weeks duration • Rockwood type III, IV, and V injuries • Patients willing to participate and provide informed consent Exclusion Criteria • Chronic AC joint dislocation • Associated fracture around shoulder girdle • Previous shoulder surgery • Neurovascular injury • Polytrauma patients medically unfit for surgery Surgical Technique All patients underwent AC joint reconstruction under general anesthesia in beach chair position. A small incision was made over the distal clavicle and coracoid process. After exposure, tunnels were drilled in the clavicle and coracoid process. Double endobutton fixation was performed using fibre wire passed through the drilled tunnels. Anatomical reduction of the AC joint was achieved under fluoroscopic guidance and fixation was secured. Wound closure was performed in layers. Postoperative Rehabilitation The operated limb was immobilized in an arm sling for 3 weeks. Pendulum exercises were initiated after 2 weeks followed by gradual passive and active range of motion exercises. Strengthening exercises were started after 6 weeks. Outcome Measures Functional assessment was done using: • Constant-Murley Shoulder Score • Visual Analog Scale (VAS) Radiological evaluation included: • Coracoclavicular distance measurement • Assessment of maintenance of reduction Statistical Analysis Data were analyzed using SPSS version 26. Quantitative variables were expressed as mean ± standard deviation. Paired t-test was used to compare preoperative and postoperative variables. A p-value less than 0.05 was considered statistically significant.

Table 1: Distribution According to Age Group

The majority of patients belonged to the 31–40 years age group, indicating that AC joint dislocation commonly affects young and active individuals. The mean age of the study population was 34.6 ± 8.2 years.

Table 2: Distribution According to Mode of Injury

Road traffic accidents were the most common cause of injury followed by sports-related trauma. This finding reflects the high-energy mechanism commonly associated with AC joint dislocation.

Table 3: Distribution According to Rockwood Classification

Rockwood type V injuries constituted the majority of cases included in the study.

Table 4: Comparison of Constant-Murley Score

There was significant improvement in functional outcome following surgery. The mean Constant-Murley Score increased progressively during follow-up and achieved excellent results at 6 months.

Table 5: Comparison of VAS Score

Postoperative pain scores showed marked reduction during follow-up indicating effective stabilization and pain relief.

Table 6: Postoperative Complications

The procedure demonstrated low complication rates with satisfactory maintenance of reduction in most patients.

Acromioclavicular joint dislocation continues to remain a challenging injury for orthopaedic surgeons due to the complex biomechanics of the shoulder girdle and the wide variety of available surgical procedures.[13] The ideal reconstruction technique should provide stable fixation, restore anatomy, permit early mobilization, and minimize complications.[14]

In the present study, the majority of patients were young males in the third and fourth decades of life. Similar findings were reported by Tauber et al who observed that AC joint dislocations predominantly affect active young adults exposed to high-energy trauma.[15] The high incidence of road traffic accidents in our study reflects the increasing burden of vehicular trauma in developing countries.

Rockwood type V injuries constituted 50% of cases in the present study. Similar predominance of severe injuries has been reported in tertiary trauma centers where high-energy injuries are frequently encountered.[16]

The Constant-Murley Score improved significantly from 38.5 preoperatively to 90.8 at final follow-up. These findings are comparable with those reported by Jensen et al who demonstrated excellent functional recovery following double endobutton fixation.[17] The anatomical restoration achieved with suspensory fixation systems contributes to improved shoulder biomechanics and functional outcomes.

The VAS pain score showed substantial reduction during follow-up. Stable fixation minimizes micromotion at the AC joint and facilitates early rehabilitation, resulting in rapid pain relief.[18]

Radiological maintenance of reduction was achieved in 93.3% of patients. Previous studies have demonstrated that double endobutton fixation provides superior vertical stability compared to isolated single-button constructs.[19] The addition of fibre wire augmentation further enhances biomechanical strength and reduces the risk of recurrent displacement.

Complications observed in the present study were minimal. Two patients developed superficial infection which responded to antibiotic therapy. Mild loss of reduction was noted in two patients but did not significantly affect functional outcome. No implant failure or neurovascular complications were encountered. Similar low complication rates have been reported in recent literature evaluating suspensory fixation techniques.[20]

Compared to hook plate fixation, double endobutton reconstruction avoids subacromial impingement and eliminates the need for implant removal surgery. Additionally, minimally invasive soft tissue dissection preserves deltotrapezial fascia integrity and facilitates faster recovery.

The limitations of the present study include relatively small sample size and shorter duration of follow-up. Long-term multicentric studies comparing different reconstruction techniques are required for further validation.

Double endobutton and fibre wire reconstruction is an effective and reliable technique for management of acute acromioclavicular joint dislocation. The procedure provides excellent functional recovery, stable radiological reduction, significant pain relief, and low complication rates. Early rehabilitation and return to routine activities can be achieved with this technique. Therefore, it may be considered a preferred surgical option for unstable AC joint injuries.

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