A modified endobutton technique for treating acromioclavicular joint dislocation

A modified endobutton technique for treating acromioclavicular joint dislocation | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Article A modified endobutton technique for treating acromioclavicular joint dislocation Wenyu Duan, Zhang Yijun, Wang Beiyu, Yu Qiang, Zhou zhou, Liu Youcai This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4259997/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Purpose: The aim of this study is to evaluate the clinical effects of the modified Endobutton surgical technique in the treatment of acromioclavicular joint dislocation. Methods A total of 46 patients with Rockwood type III-V acromioclavicular joint dislocation, treated with modified ETP (Endobutton) or CHP (clavicular hook plate) from June 2018 to May 2023 in our department, were selected as research subjects. They were divided into CHP internal fixation group (control group, n = 22) and ETP fixation group (observation group, n = 24) according to the surgical treatment method. Results The the observation group had a shorter postoperative length of hospital stay compared to the control group (P < 0.05), and the combined incidence of postoperative shoulder pain and complications was lower in the observation group compared to the control group (P < 0.05). However, the observation group had lower VAS pain scores at 3 days and 3 months postoperatively compared to the control group (P < 0.05). The observation group had a higher Constant-Murley shoulder joint function score at 3 months postoperatively compared to the control group (P < 0.05). The observation group had a significantly higher rate of excellent and good shoulder joint function recovery compared to the control group at 12 months postoperatively (P < 0.05). Conclusion The modified endobutton technique for treating acromioclavicular joint dislocation has shown promising clinical outcomes. Health sciences/Diseases Health sciences/Diseases/Trauma Acromioclavicular joint dislocation clavicular hook plate Endobutton technique Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Figure 6 1.Introduction The acromioclavicular joint is a complex linkage joint consisting of the acromioclavicular joint surface and the acromioclavicular ligament, rostral ligament and joint capsule, which anchors the clavicle to the scapula. The movement of the scapula is extremely complex and therefore treatment of a scaphoid injury can be very diffcult 1 . Acromioclavicular joint dislocation (AJD) is one of the most common injuries of the shoulder, often occurring in direct injuries such as falls or sports-related injuries. Among all shoulder injuries, acromioclavicular joint dislocations account for 9% 2 . The main manifestations of acromioclavicular joint dislocation include pain and restricted movement during shoulder jo 3,4 . According to the severity of AJD, Rockwood classified it into six grades, with Rockwood I and II injuries often treated conservatively, while Rockwood III to VI injuries are usually treated with surgery 5,6 . However, conservative treatment does not always achieve the desi 7 red therapeutic effect for many patients, hence surgical intervention is chosen for patients with high prognostic demands or who have failed conservative treatment 8–11 .With ongoing research into the reduction and fixation techniques for AJD, various treatment methods such as Kirschner wire, clavicular hook plate (CHP), and K-wire are used. However, there remains controversy over the optimal treatment method for AJD in clinical practice 12–15 . While clavicular hook plates are commonly used in recent years for AJD treatment, but there is a high incidence of complications, including postopera tive shoulder pain, limited shoulder movement, foreign body sensation, rotator cuf injury, acromion impinge ment syndrome, osteolysis of the acromion, distal clavi cle fracture and plate fracture 16–21 . In recent years, the use of Endobutton titanium plates (ETP) in the treatment of this injury has gained good therapeutic results. However, this treatment method involves the placement of two plates above the patient’s clavicle and below the coracoid process, with drilling holes in the clavicle and coracoid, often resulting in fractures at these two locations 3 . Furthermore, although arthroscopic-assisted reconstruction of the acromioclavicular ligament using Endobutton titanium plates is gradually becoming more popular, arthroscopic technology requires a high level of surgical expertise and a long learning curve. At present, complete replacement of other surgical techniques by arthroscopy will take time. Our team has developed a modified surgical technique using Endobutton titanium plates, which allows for the treatment of acromioclavicular joint dislocation through small incisions and smaller bone tunnels without the use of arthroscopy. Clinical outcomes of patients treated with ETP and CHP for AJD in our department from June 2018 to May 2023 are hereby reported. 2.Materials and methods The study was approved by our ethics committee and all patients gave their informed consent and signed the informed consent form. Inclusion criteria: Patient inclusion criteria ( 1 ) Closed unilateral Rockwood III or V subluxation of the acromioclavicular joint; ( 2 ) Age ≥ 18years; ( 3 ) Normal shoulder function before the injury; ( 4 ) Patient follows our treatment plan. Patient exclusion criteria: ( 1 ) Chronic acromioclavicular joint dislocation; ( 2 ) Patients with open injuries or vascular or nerve damage; ( 3 ) Age < 18years; ( 4 ) Patients with severe osteoporosis; ( 5 ) Patients with co-morbidities that cannot tolerate surgery; ( 6 ) Patients who refuse surgical treatment; ( 7 ) chronic acromioclavicular joint dislocation (more than 3weeks after the injury). The characteristics and clinical data of the two groups are shown in Table I. Table-1: Patients characteristics and clinical data of two groups ( X ± S). Variable CHP group(n = 22) ETP group(n = 24) number of cases 22 24 Male / female Age (year) Left/right Rockwood Ⅲ/IV/V 14/8 36.8 ± 9.3 13/9 17/1/4 15/9 36.8 ± 7.5 15/9 17/2/5 Note: compared with group C, P > 0.05. Operative technique CHP group 22 : all operations are performed by the same surgeon team.After anesthesia, the patient is positioned in the beach chair position. An incision is made above the clavicle, and the acromioclavicular joint cartilage is cleared. The pre-measured clavicular hook plate (CHP) is placed, with the hook portion of the plate inserted below the acromion, and the plate is then pressed down to reduce the acromioclavicular joint. The appropriate length screws are then drilled, measured, and inserted into the clavicle. Confirmation of reduction is done under C-arm fluoroscopy. Finally, the incision is closed layer by layer. ETP group: after anesthesia, the patient is positioned in the beach chair position. The procedure is performed under general anesthesia with the patient positioned in the beach chair position with the head elevated at 20–30°. The shoulder is additionally raised to assist in the reduction of the acromioclavicular joint. Following routine disinfection and draping, the clavicle, acromion, and coracoid process are marked on the skin surface. Reduction of the acromioclavicular joint is achieved, and a 2.0 mm Kirschner wire is temporarily inserted to stabilize the joint. Under C-arm fluoroscopy, the positioning of the C-arm X-ray machine is adjusted to achieve a true anteroposterior view of the shoulder joint, with the coracoid process appearing elliptical in the image; under fluoroscopic guidance, a 2.0 mm Kirschner wire is inserted through the center of the base of the coracoid process in a vertical direction toward the skin surface of the clavicle, which is marked for reference, as shown in Fig. 1 . A 1 cm incision is made at the marked point below the coracoid process, and blunt dissection is performed to expose the base of the coracoid process; a 2 cm incision is made, exposing the anterior and posterior edges of the clavicle approximately 3.0 cm above the distal end, followed by exploration of the anterior and posterior edges.; using a guide, a hole is drilled through the inner surface of the clavicle at a point 3.0-3.5 cm from the distal end, located at the midpoint between the anterior and posterior edges.; the guide pin is directed toward the central base of the coracoid process, with attention to protecting the surrounding vasculature and nerves, as shown in Fig. 2 , 3 . A 2.5 mm Kirschner wire is used to create a straight bone tunnel by drilling through the clavicle and coracoid process. The wire is then removed, and a guide wire is passed from the coracoid process out of the body. A second metallic wire is used to pull the titanium plate from the coracoid process to the clavicle, ensuring the plate is positioned centrally at the coracoid process. Another titanium plate is installed on the clavicle, aligning closely with the superior margin, and stitches are tightened and secured. Confirmation under fluoroscopy ensures the contact of both plates with the clavicular surface. The temporary fixation Kirschner wire is removed, and following further fluoroscopic confirmation of the well-aligned joint, excess suture is cut, and the incision is irrigated and sutured, as shown in Fig. 4 . Postoperative Treatment After the surgery, routine antibiotics are administered for 24 hours, and the drainage tube is removed within 1–2 days post-surgery. Passive pendulum exercises of the shoulder joint are initiated on the third day post-surgery for both patient groups, followed by encouraging assisted active movements 2–3 weeks post-surgery. At this stage, the shoulder joint’s abduction should not exceed 90°, and external rotation should be limited to 30°. Resistance-free rehabilitation activities can be gradually increased after 6 weeks. Within 3 months, activities involving lifting, pulling, and pushing heavy objects using the affected limb should be avoided. In the Endobutton titanium plate group, internal fixation is not removed, while in the clavicular hook plate group, the internal fixation is removed in a second surgery 10–12 months after the initial one. Clinical observation and index evaluation The comparison between the two groups of patients includes surgical time, intraoperative blood loss, length of hospital stay, and the occurrence rate of complications such as fixation failure, acromion impingement, shoulder pain, and ectopic ossification. Additionally, the comparison involves assessing the pain levels and shoulder joint function of the patients in both groups before and after 3 days, 3 months, and 12 months post-surgery, as well as evaluating the reduction status of the acromioclavicular joint dislocation (AJD) after 12 months. Pain levels are evaluated using the Visual Analogue Scale (VAS) ranging from 0 to 10, with higher scores indicating more severe pain 7 . Shoulder joint function on the affected side is assessed using the Constant-Murley score, ranging from 0 to 100, with higher scores indicating better function 23 . The reduction status of the AJD after 12 months is assessed by measuring the coracoclavicular distance on the anteroposterior radiographs, and the Karlsson grading system, which rates from excellent, good, fair, to poor, is employed for evaluation 24 . Statistical analysis This study will conduct data analysis using SPSS 22.0 software. Numerical data will be presented in the form of mean ± standard deviation (mean ± SD) and will be analyzed using t-tests. Count data will be presented as percentages (%) and analyzed using the chi-square test. Differences with P < 0.05 will be considered statistically significant. 3.Results The X-ray images of the two groups before and after operation are shown in Fig. 5 . There was no significant difference in operation time and blood loss between the two groups (P>0.05); The length of hospitalization in the observation group was significantly shorter than that in the control group (P<0.05), as shown in Table 2. Comparison of the incidence of postoperative complications between the two groups: There was no significant difference in the incidence of internal fixation failure, acromial impingement and ectopic ossification at the last postoperative follow-up between the two groups (P>0.05); The combined incidence of shoulder pain and complications in the observation group was significantly lower than that in the control group (P 0.05); VAS scores in the observation group were significantly lower than those in the control group at 3 days and 3 months after surgery (P>0.05), as shown in Table 4. There was no significant difference between the observation group and the control group in Constant-Murley scores before and 12 months after surgery (P>0.05); The Constant-Murley score was significantly higher in the observation group than in the control group 3 months after surgery (P<0.05), as shown in Table 5. The measurements of coracoclavicular space were 8.2 ± 1.7 mm in the observation group and 8.1 ± 1.8 mm in the control group 12 months after surgery, and there was no significant difference between the two groups (P>0.05). Postoperative joint recovery in the ETP group is shown in Fig. 6 . Table-2: Comparison of perioperative conditions between the two groups ( X ± s). Group n Operation time (min) Intraoperative blood loss (ml) Length of stay (d) CHP group 22 58.4 ± 8.4 90.9 ± 14.2 14.0 ± 2.5 ETP group 24 59.3 ± 9.4 85.8 ± 12.7 12.1 ± 2.7 t 0.323 1.219 2.525 p 0.749 0.229 0.015 Table-3: Comparison of postoperative complications between the two groups ( X ± s). Group n Failure of internal fixation [case(%)] Acromial impingement [case (%)] Shoulder pain [case (%)] Ectopic ossification [case (%)] Total complications [case (%)] CHP group 22 1(4.5) 3(13.6) 6(27.3) 2(9.1) 11(50.0) ETP group 24 0(0) 1(4.2) 1(4.2) 1(4.2) 3(12.5) t 1.115 1.296 4.75 0.457 7.624 P 0.291 0.255 0.029 0.499 0.006 Table-4: Comparison of preoperative and postoperative VAS scores between the two groups ( X ± s). Group n pre-operation 3 days after surgery 3 months after surgery 12 months after surgery Total complications [case(%)] CHP group 22 5.69 ± 0.60 4.36 ± 0.45 3.16 ± 0.26 1.15 ± 0.16 11(50.0) ETP group 24 5.68 ± 0.55 4.03 ± 0.47 2.82 ± 0.34 1.12 ± 0.14 3(12.5) t 0.092 2.436 3.734 0.731 7.624 P 0.927 0.019 < 0.001 0.469 0.006 Table-5: Comparison of Constant-Mur ley scores before and after surgery between the two groups ( X ± s). Group n pre-operation 3 days after surgery 3 months after surgery CHP group 22 36.9 ± 6.1 73.5 ± 8.3 84.6 ± 3.9 ETP group 24 35.9 ± 57 79.7 ± 8.1 87.2 ± 4.8 t 0.465 2.567 2.013 P 0.644 0.014 0.050 4.Conclusions AJD, a common shoulder injury in young and middle-aged adults, is correlated with injuries to the acromioclavicular ligament and coracoclavicular ligament 25 . In cases of unstable AJD, changes in the anatomical direction of the scapula may lead to shoulder movement disorders in 70% of patients who receive non-surgical treatment; additionally, 45% of patients may experience pathological scapular syndrome, including scapular malposition, medial downward rotation of the scapula, impingement pain at the coracoid process, and scapular movement disorders. Scapular movement disorders alter the dynamics of the shoulder girdle, leading to chronic shoulder pain 26 . Therefore, the treatment methods and clinical efficacy of AJD are also highly emphasized. Non-surgical treatment has been widely accepted as the gold standard for treating Rockwood I and II lesions. For injuries of Rockwood III and above, surgical treatment can better restore the anatomical relationship of the acromioclavicular joint, effectively alleviate pain and restore shoulder joint movement in the early stage, prevent and treat adhesions around the shoulder joint, and promote better restoration of shoulder joint function 12 . There are various internal fixation methods for surgical treatment of AJD, and there is currently no unified standard. The superiority of minimally invasive surgery is widely recognized, with reports indicating that open surgery is more cumbersome, causing greater damage, and lacking the direct visualization provided by arthroscopy 27 . However, the author believes that small-incision surgery is less traumatic, convenient to perform, and simple and practical, and that the use of an anterior cross locator facilitates easier navigation of bone tunnel direction. Arthroscopic techniques place high demands on the operator, with a steep learning curve; with the current level of medical development, it will take some time for arthroscopy to completely replace other procedures. The CHP treatment has good resistance to rotation, providing both horizontal and vertical stability and demonstrating excellent clinical efficacy, making it the preferred treatment method at present 28 . Nevertheless, with the widespread clinical application, it has been found that many postoperative complications may occur, such as shoulder pain to a certain extent, internal fixation failure, acromial impact, and ectopic ossification 29,30 . This study has some limitations. Firstly, the relatively small number of injuries may not fully represent the overall population. Secondly, while the ETP technique effectively controls vertical displacement of the acromioclavicular joint, its control of horizontal displacement is less satisfactory, which is considered one of the drawbacks of this surgical approach. With the increasing attention to the reconstruction of the acromioclavicular ligament and coracoclavicular ligament, a spring-fixed circular steel plate has been produced, which not only effectively stabilizes the acromioclavicular joint, but also better preserves the micro-motion function of the joint. The ETP system has reconstructed the acromioclavicular ligament in a nearly anatomical manner, repaired the stabilizing mechanism of the acromioclavicular joint from an anatomical perspective, and allowed the clavicle to rotate to a certain extent and the acromioclavicular joint to have a certain range of micro-motion, forming elastic fixation, which is not prone to stress fractures, has good biocompatibility, and does not require a second surgery, reducing the patient’s physical trauma, economic burden, and psychological trauma 31 . This study found that the incidence of shoulder pain in the postoperative observation group was significantly lower than that in the control group, and the overall incidence of complications in the observation group was also lower than that in the control group, indicating that the ETP treatment for AJD patients is more advantageous in reducing postoperative complications compared to CHP treatment. In addition, this study found through at least 1 year of follow-up that the observation group had better VAS scores at 3 days and 3 months postoperatively, better Constant-Murley scores at 3 months postoperatively, and a higher rate of excellent shoulder joint function recovery at 12 months postoperatively compared to the control group. These results indicate that the clinical efficacy of ETP treatment for Rockwood III-V type AJD is relatively superior to CHP treatment in terms of the occurrence rate of shoulder pain and other complications, postoperative pain reduction, and joint function recovery. The modified ETP technique has several advantages: It fully achieves the principles of minimally invasive surgery by minimizing surgical incisions, reducing intraoperative blood loss, and simplifying the operation without the use of arthroscopy.By drilling smaller bone tunnels separately in the clavicle and coracoid process, it reduces bone loss and lowers the incidence of fracture. In summary, the clinical efficacy of ETP in treating Rockwood types III-V acromioclavicular joint dislocation (AJD) is relatively superior to traditional CHP in terms of reducing complications such as shoulder pain, alleviating postoperative pain, and achieving joint function recovery. However, the long-term effects still require further exploration and validation through large-sample, multi-center, prospective, randomized controlled trials. Declarations Author Contributions: D.Y. and Z.J. wrote the main manuscript text .W.Y. and Y.Q.prepared figures 1-6. Z.M. and L.C.prepared tabies 1-5.All authors reviewed the manuscript. Funding : This research received no external funding. Institutional Review Board Statement: This retrospective study involving human subjects is in accordance with the principles of the Declaration of Helsinki. This study was approved by The first affiliated hopital of BaoTou Medical College,inner mongolia university of science and technology Review Board. Furthermore,as this study is retrospective in nature, informed consent could not be obtained from all subjects. Therefore, a written consent exemption letter for this matter was approved by the Institutional Review Board in order to proceed with the study. Informed Consent Statement: All authors consented for publication. Data availability Data is provided within the manuscript or supplementary information files. Conflicts of Interest: All authors declare no competing financial interest. References Mazzocca, A. D., Arciero, R. A. & Bicos, J. Evaluation and treatment of acromioclavicular joint injuries. Am J Sports Med 35, 316–329 (2007). https://doi.org/10.1177/0363546506298022 Bigoni, M. et al. Clinical effectiveness of surgical treatment with polyester tapes and temporary K-wires on complete acromioclavicular dislocation. Eur J Orthop Surg Traumatol 29, 567–573 (2019). https://doi.org/10.1007/s00590-018-2321-9 Schliemann, B. et al. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4259997","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Article","associatedPublications":[],"authors":[{"id":292312669,"identity":"e319b049-b054-4180-8678-2f460bc24317","order_by":0,"name":"Wenyu Duan","email":"","orcid":"","institution":"BaoTou Medical College, inner mongolia university of science and technology","correspondingAuthor":false,"prefix":"","firstName":"Wenyu","middleName":"","lastName":"Duan","suffix":""},{"id":292312670,"identity":"6a5c22e8-eb80-4e95-92ca-9b56423bc840","order_by":1,"name":"Zhang Yijun","email":"","orcid":"","institution":"inner mongolia university of science and technology","correspondingAuthor":false,"prefix":"","firstName":"Zhang","middleName":"","lastName":"Yijun","suffix":""},{"id":292312672,"identity":"a6b39f16-aaf8-4d62-b9a5-4c3c0edad538","order_by":2,"name":"Wang Beiyu","email":"","orcid":"","institution":"BaoTou Medical College, inner mongolia university of science and technology","correspondingAuthor":false,"prefix":"","firstName":"Wang","middleName":"","lastName":"Beiyu","suffix":""},{"id":292312673,"identity":"e93cfdaf-dce0-42ad-baba-175538903fa5","order_by":3,"name":"Yu Qiang","email":"","orcid":"","institution":"inner mongolia university of science and technology","correspondingAuthor":false,"prefix":"","firstName":"Yu","middleName":"","lastName":"Qiang","suffix":""},{"id":292312674,"identity":"b7227091-30d0-4fe5-9b30-edbb6cc6ae20","order_by":4,"name":"Zhou zhou","email":"","orcid":"","institution":"inner mongolia university of science and technology","correspondingAuthor":false,"prefix":"","firstName":"Zhou","middleName":"","lastName":"zhou","suffix":""},{"id":292312675,"identity":"cc9c6083-62c3-4a7a-8946-7c4caab20bf6","order_by":5,"name":"Liu Youcai","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAArElEQVRIiWNgGAWjYJACCQYGGx5+/gZi1bOBtaTJSM44QJqWwzYGDQlE6pCf3/7wNu+O8zwGDAcYP3zMIUILYxuPseXMM7d5zJkbmCVnbiNCCzMbD5vEx7bbPJYNB9iYeYnRwsbG/kwise0cj8GBBCK18LAxmAFtOUCCFgm2HKBf2pJ5JGccbCbOL/LNx4Eh1mZnz8/ffPDDR2K0IAHGBtLUj4JRMApGwSjADQB9Dy+fuP5voQAAAABJRU5ErkJggg==","orcid":"","institution":"inner mongolia university of science and technology","correspondingAuthor":true,"prefix":"","firstName":"Liu","middleName":"","lastName":"Youcai","suffix":""}],"badges":[],"createdAt":"2024-04-13 01:29:20","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4259997/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4259997/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":55324414,"identity":"8c7691ea-18fc-4640-998e-1f3ee27382eb","added_by":"auto","created_at":"2024-04-25 16:50:11","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":98871,"visible":true,"origin":"","legend":"\u003cp\u003ea 2.0 mm Kirschner wire is inserted through the center of the base of the coracoid process in a vertical direction toward the skin surface of the clavicle\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-4259997/v1/69ed3d75cd8dcf5fb2a2e849.png"},{"id":55324413,"identity":"31eab851-3106-49bc-a3f2-16cd1a9a974f","added_by":"auto","created_at":"2024-04-25 16:50:11","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":302124,"visible":true,"origin":"","legend":"\u003cp\u003ea 2 cm incision and 3.0 cm incision\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-4259997/v1/7e366f786bde19c6b6432e4c.png"},{"id":55324417,"identity":"89f17377-5c71-458e-865b-37eb795d1c1d","added_by":"auto","created_at":"2024-04-25 16:50:11","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":217643,"visible":true,"origin":"","legend":"\u003cp\u003e2cm incision and 3.0cm incision after suturing\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-4259997/v1/4e5b08d31b3a25609a8dfe13.png"},{"id":55324415,"identity":"3cbcb501-0d74-42fa-bfb8-96b25be41f2c","added_by":"auto","created_at":"2024-04-25 16:50:11","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":240093,"visible":true,"origin":"","legend":"\u003cp\u003ePostoperative endobutton position\u003c/p\u003e","description":"","filename":"4.png","url":"https://assets-eu.researchsquare.com/files/rs-4259997/v1/62fa8ee3ca3ab9380edf0456.png"},{"id":55324416,"identity":"2fd1c13e-ed02-4676-8146-c5aa48288978","added_by":"auto","created_at":"2024-04-25 16:50:11","extension":"png","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":829257,"visible":true,"origin":"","legend":"\u003cp\u003eETP group: A is a preoperative X-ray, B is a 3-day postoperative X-ray, C is a one-month postoperative X-ray; CHP group: D is a preoperative X-ray, E is a 3-day postoperative X-ray, F is a one-month postoperative X-ray\u003c/p\u003e","description":"","filename":"5.png","url":"https://assets-eu.researchsquare.com/files/rs-4259997/v1/3dd0ceba339b07895a041f1c.png"},{"id":55324418,"identity":"d7d569cd-f5a7-4142-995b-33d4d96658e5","added_by":"auto","created_at":"2024-04-25 16:50:11","extension":"png","order_by":6,"title":"Figure 6","display":"","copyAsset":false,"role":"figure","size":1070937,"visible":true,"origin":"","legend":"\u003cp\u003eETP group patients with postoperative related actions, A: Naturally sagging; B: Outreach 90°; C: Extension 30°; D: Forward bend up 130\u003c/p\u003e","description":"","filename":"6.png","url":"https://assets-eu.researchsquare.com/files/rs-4259997/v1/29789a4871c549cc4d71e7d3.png"},{"id":61629810,"identity":"6f95c073-a710-4dc7-9c3c-e242700852bc","added_by":"auto","created_at":"2024-08-02 07:40:01","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":9133004,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4259997/v1/92e83c31-e67f-41ee-999c-7795a3965f69.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"A modified endobutton technique for treating acromioclavicular joint dislocation","fulltext":[{"header":"1.Introduction","content":"\u003cp\u003eThe acromioclavicular joint is a complex linkage joint consisting of the acromioclavicular joint surface and the acromioclavicular ligament, rostral ligament and joint capsule, which anchors the clavicle to the scapula. The movement of the scapula is extremely complex and therefore treatment of a scaphoid injury can be very diffcult\u003csup\u003e1\u003c/sup\u003e. Acromioclavicular joint dislocation (AJD) is one of the most common injuries of the shoulder, often occurring in direct injuries such as falls or sports-related injuries. Among all shoulder injuries, acromioclavicular joint dislocations account for 9%\u003csup\u003e2\u003c/sup\u003e. The main manifestations of acromioclavicular joint dislocation include pain and restricted movement during shoulder jo\u003csup\u003e3,4\u003c/sup\u003e. According to the severity of AJD, Rockwood classified it into six grades, with Rockwood I and II injuries often treated conservatively, while Rockwood III to VI injuries are usually treated with surgery\u003csup\u003e5,6\u003c/sup\u003e. However, conservative treatment does not always achieve the desi\u003csup\u003e7\u003c/sup\u003ered therapeutic effect for many patients, hence surgical intervention is chosen for patients with high prognostic demands or who have failed conservative treatment\u003csup\u003e8\u0026ndash;11\u003c/sup\u003e.With ongoing research into the reduction and fixation techniques for AJD, various treatment methods such as Kirschner wire, clavicular hook plate (CHP), and K-wire are used. However, there remains controversy over the optimal treatment method for AJD in clinical practice\u003csup\u003e12\u0026ndash;15\u003c/sup\u003e. While clavicular hook plates are commonly used in recent years for AJD treatment, but there is a high incidence of complications, including postopera tive shoulder pain, limited shoulder movement, foreign body sensation, rotator cuf injury, acromion impinge ment syndrome, osteolysis of the acromion, distal clavi cle fracture and plate fracture\u003csup\u003e16\u0026ndash;21\u003c/sup\u003e. In recent years, the use of Endobutton titanium plates (ETP) in the treatment of this injury has gained good therapeutic results. However, this treatment method involves the placement of two plates above the patient\u0026rsquo;s clavicle and below the coracoid process, with drilling holes in the clavicle and coracoid, often resulting in fractures at these two locations\u003csup\u003e3\u003c/sup\u003e. Furthermore, although arthroscopic-assisted reconstruction of the acromioclavicular ligament using Endobutton titanium plates is gradually becoming more popular, arthroscopic technology requires a high level of surgical expertise and a long learning curve. At present, complete replacement of other surgical techniques by arthroscopy will take time. Our team has developed a modified surgical technique using Endobutton titanium plates, which allows for the treatment of acromioclavicular joint dislocation through small incisions and smaller bone tunnels without the use of arthroscopy. Clinical outcomes of patients treated with ETP and CHP for AJD in our department from June 2018 to May 2023 are hereby reported.\u003c/p\u003e"},{"header":"2.Materials and methods","content":"\u003cp\u003e The study was approved by our ethics committee and all patients gave their informed consent and signed the informed consent form.\u003c/p\u003e \u003cp\u003eInclusion criteria: Patient inclusion criteria (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e) Closed unilateral Rockwood III or V subluxation of the acromioclavicular joint; (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e) Age\u0026thinsp;\u0026ge;\u0026thinsp;18years; (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e) Normal shoulder function before the injury; (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e) Patient follows our treatment plan. Patient exclusion criteria: (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e) Chronic acromioclavicular joint dislocation; (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e) Patients with open injuries or vascular or nerve damage; (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e) Age\u0026thinsp;\u0026lt;\u0026thinsp;18years; (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e) Patients with severe osteoporosis; (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e) Patients with co-morbidities that cannot tolerate surgery; (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e) Patients who refuse surgical treatment; (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e) chronic acromioclavicular joint dislocation (more than 3weeks after the injury). The characteristics and clinical data of the two groups are shown in Table I.\u003c/p\u003e \u003cp\u003eTable-1: Patients characteristics and clinical data of two groups ( X\u0026thinsp;\u0026plusmn;\u0026thinsp;S).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Taba\" border=\"1\"\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCHP group(n\u0026thinsp;=\u0026thinsp;22)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eETP group(n\u0026thinsp;=\u0026thinsp;24)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003enumber of cases\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e24\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale / female\u003c/p\u003e \u003cp\u003eAge (year)\u003c/p\u003e \u003cp\u003eLeft/right\u003c/p\u003e \u003cp\u003eRockwood Ⅲ/IV/V\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e14/8\u003c/p\u003e \u003cp\u003e36.8\u0026thinsp;\u0026plusmn;\u0026thinsp;9.3\u003c/p\u003e \u003cp\u003e13/9\u003c/p\u003e \u003cp\u003e17/1/4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15/9\u003c/p\u003e \u003cp\u003e36.8\u0026thinsp;\u0026plusmn;\u0026thinsp;7.5\u003c/p\u003e \u003cp\u003e15/9\u003c/p\u003e \u003cp\u003e17/2/5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"3\"\u003eNote: compared with group C, P\u0026thinsp;\u0026gt;\u0026thinsp;0.05.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e\u003cb\u003eOperative technique\u003c/p\u003e\u003cp\u003eCHP group\u003csup\u003e22\u003c/sup\u003e: all operations are performed by the same surgeon team.After anesthesia, the patient is positioned in the beach chair position. An incision is made above the clavicle, and the acromioclavicular joint cartilage is cleared. The pre-measured clavicular hook plate (CHP) is placed, with the hook portion of the plate inserted below the acromion, and the plate is then pressed down to reduce the acromioclavicular joint. The appropriate length screws are then drilled, measured, and inserted into the clavicle. Confirmation of reduction is done under C-arm fluoroscopy. Finally, the incision is closed layer by layer.\u003c/p\u003e \u003cp\u003eETP group: after anesthesia, the patient is positioned in the beach chair position. The procedure is performed under general anesthesia with the patient positioned in the beach chair position with the head elevated at 20\u0026ndash;30\u0026deg;. The shoulder is additionally raised to assist in the reduction of the acromioclavicular joint. Following routine disinfection and draping, the clavicle, acromion, and coracoid process are marked on the skin surface. Reduction of the acromioclavicular joint is achieved, and a 2.0 mm Kirschner wire is temporarily inserted to stabilize the joint. Under C-arm fluoroscopy, the positioning of the C-arm X-ray machine is adjusted to achieve a true anteroposterior view of the shoulder joint, with the coracoid process appearing elliptical in the image; under fluoroscopic guidance, a 2.0 mm Kirschner wire is inserted through the center of the base of the coracoid process in a vertical direction toward the skin surface of the clavicle, which is marked for reference, as shown in Fig.\u0026nbsp;\u003cspan refid=\"Fig5\" class=\"InternalRef\"\u003e1\u003c/span\u003e. A 1 cm incision is made at the marked point below the coracoid process, and blunt dissection is performed to expose the base of the coracoid process; a 2 cm incision is made, exposing the anterior and posterior edges of the clavicle approximately 3.0 cm above the distal end, followed by exploration of the anterior and posterior edges.; using a guide, a hole is drilled through the inner surface of the clavicle at a point 3.0-3.5 cm from the distal end, located at the midpoint between the anterior and posterior edges.; the guide pin is directed toward the central base of the coracoid process, with attention to protecting the surrounding vasculature and nerves, as shown in Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e,\u003cspan refid=\"Fig6\" class=\"InternalRef\"\u003e3\u003c/span\u003e. A 2.5 mm Kirschner wire is used to create a straight bone tunnel by drilling through the clavicle and coracoid process. The wire is then removed, and a guide wire is passed from the coracoid process out of the body. A second metallic wire is used to pull the titanium plate from the coracoid process to the clavicle, ensuring the plate is positioned centrally at the coracoid process. Another titanium plate is installed on the clavicle, aligning closely with the superior margin, and stitches are tightened and secured. Confirmation under fluoroscopy ensures the contact of both plates with the clavicular surface. The temporary fixation Kirschner wire is removed, and following further fluoroscopic confirmation of the well-aligned joint, excess suture is cut, and the incision is irrigated and sutured, as shown in Fig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003e.\u003c/p\u003e\u003cp\u003e \u003cstrong\u003ePostoperative Treatment\u003c/strong\u003e \u003cp\u003eAfter the surgery, routine antibiotics are administered for 24 hours, and the drainage tube is removed within 1\u0026ndash;2 days post-surgery. Passive pendulum exercises of the shoulder joint are initiated on the third day post-surgery for both patient groups, followed by encouraging assisted active movements 2\u0026ndash;3 weeks post-surgery. At this stage, the shoulder joint\u0026rsquo;s abduction should not exceed 90\u0026deg;, and external rotation should be limited to 30\u0026deg;. Resistance-free rehabilitation activities can be gradually increased after 6 weeks. Within 3 months, activities involving lifting, pulling, and pushing heavy objects using the affected limb should be avoided. In the Endobutton titanium plate group, internal fixation is not removed, while in the clavicular hook plate group, the internal fixation is removed in a second surgery 10\u0026ndash;12 months after the initial one.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eClinical observation and index evaluation\u003c/strong\u003e \u003cp\u003eThe comparison between the two groups of patients includes surgical time, intraoperative blood loss, length of hospital stay, and the occurrence rate of complications such as fixation failure, acromion impingement, shoulder pain, and ectopic ossification. Additionally, the comparison involves assessing the pain levels and shoulder joint function of the patients in both groups before and after 3 days, 3 months, and 12 months post-surgery, as well as evaluating the reduction status of the acromioclavicular joint dislocation (AJD) after 12 months. Pain levels are evaluated using the Visual Analogue Scale (VAS) ranging from 0 to 10, with higher scores indicating more severe pain\u003csup\u003e7\u003c/sup\u003e. Shoulder joint function on the affected side is assessed using the Constant-Murley score, ranging from 0 to 100, with higher scores indicating better function\u003csup\u003e23\u003c/sup\u003e. The reduction status of the AJD after 12 months is assessed by measuring the coracoclavicular distance on the anteroposterior radiographs, and the Karlsson grading system, which rates from excellent, good, fair, to poor, is employed for evaluation\u003csup\u003e24\u003c/sup\u003e.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eStatistical analysis\u003c/strong\u003e \u003cp\u003eThis study will conduct data analysis using SPSS 22.0 software. Numerical data will be presented in the form of mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation (mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD) and will be analyzed using t-tests. Count data will be presented as percentages (%) and analyzed using the chi-square test. Differences with P\u0026thinsp;\u0026lt;\u0026thinsp;0.05 will be considered statistically significant.\u003c/p\u003e \u003c/p\u003e"},{"header":"3.Results","content":"\u003cp\u003eThe X-ray images of the two groups before and after operation are shown in Fig.\u0026nbsp;\u003cspan refid=\"Fig10\" class=\"InternalRef\"\u003e5\u003c/span\u003e. There was no significant difference in operation time and blood loss between the two groups (P\u0026gt;0.05); The length of hospitalization in the observation group was significantly shorter than that in the control group (P\u0026lt;0.05), as shown in Table\u0026nbsp;2. Comparison of the incidence of postoperative complications between the two groups: There was no significant difference in the incidence of internal fixation failure, acromial impingement and ectopic ossification at the last postoperative follow-up between the two groups (P\u0026gt;0.05); The combined incidence of shoulder pain and complications in the observation group was significantly lower than that in the control group (P\u0026lt; 0.05), as shown in Table\u0026nbsp;3. There was no significant difference in VAS scores between the two groups before and 12 months after surgery (P\u0026thinsp;\u0026gt;\u0026thinsp;0.05); VAS scores in the observation group were significantly lower than those in the control group at 3 days and 3 months after surgery (P\u0026gt;0.05), as shown in Table\u0026nbsp;4. There was no significant difference between the observation group and the control group in Constant-Murley scores before and 12 months after surgery (P\u0026gt;0.05); The Constant-Murley score was significantly higher in the observation group than in the control group 3 months after surgery (P\u0026lt;0.05), as shown in Table\u0026nbsp;5. The measurements of coracoclavicular space were 8.2\u0026thinsp;\u0026plusmn;\u0026thinsp;1.7 mm in the observation group and 8.1\u0026thinsp;\u0026plusmn;\u0026thinsp;1.8 mm in the control group 12 months after surgery, and there was no significant difference between the two groups (P\u0026gt;0.05). Postoperative joint recovery in the ETP group is shown in Fig.\u0026nbsp;\u003cspan refid=\"Fig15\" class=\"InternalRef\"\u003e6\u003c/span\u003e.\u003c/p\u003e \u003cp\u003eTable-2: Comparison of perioperative conditions between the two groups ( X\u0026thinsp;\u0026plusmn;\u0026thinsp;s).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Tabb\" border=\"1\"\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGroup\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003en\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eOperation\u003c/p\u003e \u003cp\u003etime (min)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eIntraoperative\u003c/p\u003e \u003cp\u003eblood loss (ml)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eLength of\u003c/p\u003e \u003cp\u003estay (d)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCHP group\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e58.4\u0026thinsp;\u0026plusmn;\u0026thinsp;8.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e90.9\u0026thinsp;\u0026plusmn;\u0026thinsp;14.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e14.0\u0026thinsp;\u0026plusmn;\u0026thinsp;2.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eETP group\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e59.3\u0026thinsp;\u0026plusmn;\u0026thinsp;9.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e85.8\u0026thinsp;\u0026plusmn;\u0026thinsp;12.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e12.1\u0026thinsp;\u0026plusmn;\u0026thinsp;2.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003et\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.323\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.219\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.525\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ep\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.749\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.229\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.015\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eTable-3: Comparison of postoperative complications between the two groups ( X\u0026thinsp;\u0026plusmn;\u0026thinsp;s).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Tabc\" border=\"1\"\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGroup\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003en\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFailure of internal fixation [case(%)]\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eAcromial impingement [case (%)]\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eShoulder pain [case (%)]\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eEctopic ossification [case (%)]\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eTotal complications [case (%)]\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCHP group\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1(4.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e3(13.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e6(27.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e2(9.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e11(50.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eETP group\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0(0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1(4.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1(4.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1(4.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e3(12.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003et\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.115\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.296\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e4.75\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.457\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e7.624\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eP\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.291\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.255\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.029\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.499\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.006\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eTable-4: Comparison of preoperative and postoperative VAS scores between the two groups ( X\u0026thinsp;\u0026plusmn;\u0026thinsp;s).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Tabd\" border=\"1\"\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGroup\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003en\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003epre-operation\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3 days after surgery\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3 months after surgery\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003e12 months after surgery\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eTotal complications [case(%)]\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCHP group\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5.69\u0026thinsp;\u0026plusmn;\u0026thinsp;0.60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4.36\u0026thinsp;\u0026plusmn;\u0026thinsp;0.45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3.16\u0026thinsp;\u0026plusmn;\u0026thinsp;0.26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.15\u0026thinsp;\u0026plusmn;\u0026thinsp;0.16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e11(50.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eETP group\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5.68\u0026thinsp;\u0026plusmn;\u0026thinsp;0.55\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4.03\u0026thinsp;\u0026plusmn;\u0026thinsp;0.47\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.82\u0026thinsp;\u0026plusmn;\u0026thinsp;0.34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.12\u0026thinsp;\u0026plusmn;\u0026thinsp;0.14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e3(12.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003et\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.092\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.436\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3.734\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.731\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e7.624\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eP\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.927\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.019\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.469\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e0.006\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eTable-5: Comparison of Constant-Mur ley scores before and after surgery between the two groups ( X\u0026thinsp;\u0026plusmn;\u0026thinsp;s).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Tabe\" border=\"1\"\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGroup\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003en\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003epre-operation\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3 days after surgery\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3 months after surgery\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCHP group\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e36.9\u0026thinsp;\u0026plusmn;\u0026thinsp;6.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e73.5\u0026thinsp;\u0026plusmn;\u0026thinsp;8.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e84.6\u0026thinsp;\u0026plusmn;\u0026thinsp;3.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eETP group\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e35.9\u0026thinsp;\u0026plusmn;\u0026thinsp;57\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e79.7\u0026thinsp;\u0026plusmn;\u0026thinsp;8.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e87.2\u0026thinsp;\u0026plusmn;\u0026thinsp;4.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003et\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.465\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.567\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.013\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eP\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.644\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.014\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.050\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e"},{"header":"4.Conclusions","content":"\u003cp\u003eAJD, a common shoulder injury in young and middle-aged adults, is correlated with injuries to the acromioclavicular ligament and coracoclavicular ligament\u003csup\u003e25\u003c/sup\u003e. In cases of unstable AJD, changes in the anatomical direction of the scapula may lead to shoulder movement disorders in 70% of patients who receive non-surgical treatment; additionally, 45% of patients may experience pathological scapular syndrome, including scapular malposition, medial downward rotation of the scapula, impingement pain at the coracoid process, and scapular movement disorders. Scapular movement disorders alter the dynamics of the shoulder girdle, leading to chronic shoulder pain\u003csup\u003e26\u003c/sup\u003e. Therefore, the treatment methods and clinical efficacy of AJD are also highly emphasized.\u003c/p\u003e \u003cp\u003eNon-surgical treatment has been widely accepted as the gold standard for treating Rockwood I and II lesions. For injuries of Rockwood III and above, surgical treatment can better restore the anatomical relationship of the acromioclavicular joint, effectively alleviate pain and restore shoulder joint movement in the early stage, prevent and treat adhesions around the shoulder joint, and promote better restoration of shoulder joint function\u003csup\u003e12\u003c/sup\u003e. There are various internal fixation methods for surgical treatment of AJD, and there is currently no unified standard. The superiority of minimally invasive surgery is widely recognized, with reports indicating that open surgery is more cumbersome, causing greater damage, and lacking the direct visualization provided by arthroscopy\u003csup\u003e27\u003c/sup\u003e. However, the author believes that small-incision surgery is less traumatic, convenient to perform, and simple and practical, and that the use of an anterior cross locator facilitates easier navigation of bone tunnel direction. Arthroscopic techniques place high demands on the operator, with a steep learning curve; with the current level of medical development, it will take some time for arthroscopy to completely replace other procedures. The CHP treatment has good resistance to rotation, providing both horizontal and vertical stability and demonstrating excellent clinical efficacy, making it the preferred treatment method at present\u003csup\u003e28\u003c/sup\u003e. Nevertheless, with the widespread clinical application, it has been found that many postoperative complications may occur, such as shoulder pain to a certain extent, internal fixation failure, acromial impact, and ectopic ossification\u003csup\u003e29,30\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eThis study has some limitations. Firstly, the relatively small number of injuries may not fully represent the overall population. Secondly, while the ETP technique effectively controls vertical displacement of the acromioclavicular joint, its control of horizontal displacement is less satisfactory, which is considered one of the drawbacks of this surgical approach.\u003c/p\u003e \u003cp\u003eWith the increasing attention to the reconstruction of the acromioclavicular ligament and coracoclavicular ligament, a spring-fixed circular steel plate has been produced, which not only effectively stabilizes the acromioclavicular joint, but also better preserves the micro-motion function of the joint. The ETP system has reconstructed the acromioclavicular ligament in a nearly anatomical manner, repaired the stabilizing mechanism of the acromioclavicular joint from an anatomical perspective, and allowed the clavicle to rotate to a certain extent and the acromioclavicular joint to have a certain range of micro-motion, forming elastic fixation, which is not prone to stress fractures, has good biocompatibility, and does not require a second surgery, reducing the patient\u0026rsquo;s physical trauma, economic burden, and psychological trauma\u003csup\u003e31\u003c/sup\u003e. This study found that the incidence of shoulder pain in the postoperative observation group was significantly lower than that in the control group, and the overall incidence of complications in the observation group was also lower than that in the control group, indicating that the ETP treatment for AJD patients is more advantageous in reducing postoperative complications compared to CHP treatment. In addition, this study found through at least 1 year of follow-up that the observation group had better VAS scores at 3 days and 3 months postoperatively, better Constant-Murley scores at 3 months postoperatively, and a higher rate of excellent shoulder joint function recovery at 12 months postoperatively compared to the control group. These results indicate that the clinical efficacy of ETP treatment for Rockwood III-V type AJD is relatively superior to CHP treatment in terms of the occurrence rate of shoulder pain and other complications, postoperative pain reduction, and joint function recovery.\u003c/p\u003e \u003cp\u003eThe modified ETP technique has several advantages: It fully achieves the principles of minimally invasive surgery by minimizing surgical incisions, reducing intraoperative blood loss, and simplifying the operation without the use of arthroscopy.By drilling smaller bone tunnels separately in the clavicle and coracoid process, it reduces bone loss and lowers the incidence of fracture.\u003c/p\u003e \u003cp\u003eIn summary, the clinical efficacy of ETP in treating Rockwood types III-V acromioclavicular joint dislocation (AJD) is relatively superior to traditional CHP in terms of reducing complications such as shoulder pain, alleviating postoperative pain, and achieving joint function recovery. However, the long-term effects still require further exploration and validation through large-sample, multi-center, prospective, randomized controlled trials.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAuthor Contributions:\u003c/strong\u003e D.Y. and Z.J. wrote the main manuscript text .W.Y. and Y.Q.prepared figures 1-6. Z.M. and L.C.prepared tabies 1-5.All authors reviewed the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e: This research received no external funding.\u003c/p\u003e\n\u003cp\u003eInstitutional Review Board Statement: This retrospective study involving human subjects is in accordance with the principles of the Declaration of Helsinki. This study was approved by The first affiliated hopital of BaoTou \u0026nbsp;Medical \u0026nbsp; College,inner mongolia university of science and technology Review Board. Furthermore,as this study is retrospective in nature, informed consent could not be obtained from all subjects. Therefore, a written consent exemption letter for this matter was approved by the Institutional Review Board in order to proceed with the study.\u003c/p\u003e\n\u003cp\u003eInformed Consent Statement: All authors consented for publication.\u003c/p\u003e\n\u003ch3\u003eData availability\u003c/h3\u003e\n\u003cp\u003eData is provided within the manuscript or supplementary information files.\u003c/p\u003e\n\u003cp\u003eConflicts of Interest: All authors declare no competing financial interest.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eMazzocca, A. D., Arciero, R. A. \u0026amp; Bicos, J. Evaluation and treatment of acromioclavicular joint injuries. 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D. \u003cem\u003eet al.\u003c/em\u003e [Comparison of the effect of arthroscopy assisted TightRope plate and Triple-Endobutton plate and Double Endobutton plate in the treatment of acromioclavicular dislocation]. Zhongguo Gu Shang 33, 696\u0026ndash;702 (2020). \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.12200/j.issn.1003-0034.2020.08.002\u003c/span\u003e\u003cspan address=\"10.12200/j.issn.1003-0034.2020.08.002\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Acromioclavicular joint dislocation, clavicular hook plate, Endobutton technique","lastPublishedDoi":"10.21203/rs.3.rs-4259997/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4259997/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003ePurpose:\u003c/h2\u003e \u003cp\u003eThe aim of this study is to evaluate the clinical effects of the modified Endobutton surgical technique in the treatment of acromioclavicular joint dislocation.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eA total of 46 patients with Rockwood type III-V acromioclavicular joint dislocation, treated with modified ETP (Endobutton) or CHP (clavicular hook plate) from June 2018 to May 2023 in our department, were selected as research subjects. They were divided into CHP internal fixation group (control group, n\u0026thinsp;=\u0026thinsp;22) and ETP fixation group (observation group, n\u0026thinsp;=\u0026thinsp;24) according to the surgical treatment method.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eThe the observation group had a shorter postoperative length of hospital stay compared to the control group (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05), and the combined incidence of postoperative shoulder pain and complications was lower in the observation group compared to the control group (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05). However, the observation group had lower VAS pain scores at 3 days and 3 months postoperatively compared to the control group (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05). The observation group had a higher Constant-Murley shoulder joint function score at 3 months postoperatively compared to the control group (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05). The observation group had a significantly higher rate of excellent and good shoulder joint function recovery compared to the control group at 12 months postoperatively (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05).\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eThe modified endobutton technique for treating acromioclavicular joint dislocation has shown promising clinical outcomes.\u003c/p\u003e","manuscriptTitle":"A modified endobutton technique for treating acromioclavicular joint dislocation","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-04-25 16:50:06","doi":"10.21203/rs.3.rs-4259997/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"8d1b6c1b-0236-448b-ae75-88eec0af4443","owner":[],"postedDate":"April 25th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":30795474,"name":"Health sciences/Diseases"},{"id":30795475,"name":"Health sciences/Diseases/Trauma"}],"tags":[],"updatedAt":"2024-08-02T07:31:50+00:00","versionOfRecord":[],"versionCreatedAt":"2024-04-25 16:50:06","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4259997","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4259997","identity":"rs-4259997","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}