Coracoclavicular Fixation Using the Tight Rope Technique in Acute Acromioclavicular Joint Dislocations: A Comprehensive Review

Abstract

Background: Acromioclavicular (AC) joint dislocations are common shoulder injuries, particularly in young and active individuals. While conservative management is often considered for low-grade injuries, surgical intervention is preferred for high-grade (Rockwood type III-V) dislocations to restore anatomical alignment and shoulder function. Various surgical techniques have been explored, with coracoclavicular (CC) fixation using a tight rope system emerging as a promising alternative to traditional methods. This review aims to analyze the current literature on the effectiveness, biomechanics, clinical outcomes, and complications associated with the tight rope technique in the management of acute AC joint dislocations. A comprehensive review of the literature was conducted using databases such as PubMed, Scopus, and Google Scholar. Studies evaluating the tight rope technique for CC fixation in acute AC joint dislocations were included. The review focused on surgical technique, functional outcomes, radiological assessment, complications, and comparative studies with other fixation methods such as hook plates, screw fixation, and ligament reconstruction.The literature suggests that CC fixation using the tight rope system provides satisfactory outcomes in terms of joint stability, functional recovery, and pain relief. Several studies report significant improvements in functional scores, including the Constant-Murley Score (CMS) and the American Shoulder and Elbow Surgeons (ASES) score, with high patient satisfaction rates. Radiographic evaluations indicate effective joint reduction, although some studies highlight potential concerns regarding loss of reduction over time, implant loosening, and risk of coracoid fractures. Comparative studies suggest that the tight rope technique may offer advantages over hook plates by allowing early mobilization and avoiding the need for implant removal. However, the long-term superiority of this technique remains debated due to variability in reported complications and recurrence rates.Coracoclavicular fixation using the tight rope technique represents a minimally invasive and biomechanically favorable option for managing acute AC joint dislocations. While short- to mid-term outcomes are promising, further high-quality randomized controlled trials and long-term studies are required to establish its efficacy relative to other fixation methods. Standardized surgical techniques and postoperative rehabilitation protocols may enhance the consistency of results and optimize patient outcomes.