Suture Button Could Result in More Functional Outcomes Improvement and Pain Relief Than Hook Plate Technique for Treating Acute Acromioclavicular Joint Dislocation: A Systematic Review of Comparative Studies

Purpose: To systematically review the current evidence to compare the differences in outcomes of the suture button (SB) versus hook plate (HP) fixations for treating acute acromioclavicular joint dislocation (ACD). Methods: Two independent reviewers performed the literature search based on the Preferred Reporting Items for Systematic Reviews and MetaAnalyses guidelines. A literature search of the Embase, PubMed, and Cochrane Library databases was performed and Level I-IV evidence studies comparing the SB and HP procedures for acute ACD were included. Studies that met the following exclusion criteria were excluded: (1) letters, comments, case reports, reviews, animal studies, cadaveric studies, biomechanical studies, and study protocols; (2) incomplete data; and (3) repeated studies and data. The NewcastleeOttawa Scale was used to evaluate the quality of nonrandomized studies. Constant score, visual analog scale (VAS) score, operation time, coracoclavicular distance (CCD), and complications were recorded and the mean differences of VAS and Constant were compared with preset minimal clinically important difference. Results: Fourteen studies with 363 patients treated with SB procedures and 432 patients with the HP procedure were included. In terms of patientreported outcomes, 5 of the 13 included studies reported significantly greater Constant score in SB group and most (4/ 5) used arthroscopic SB technique. Statistically significant differences in favor of SB were found in 3 of the 7 included studies in terms of VAS score whereas none of them reached the minimal clinically important difference. In terms of recurrent instability, no statistically significant difference was noted. All studies showed that the SB technique resulted in lower estimated blood loss. No difference was detected in CCD and complications. Conclusions: Based on the current body of evidence, it is suggested that employment of the SB technique may confer advantageous outcomes when compared to the HP technique in acute ACD patients. These potential benefits may include higher Constant scores, lower pain levels, and no discernible increases in operation time, CCD, or complication rates. Level of Evidence: Level IV, systematic review of Level II-IV studies.