Comparison of Tightrope and Hook Plate Surgical Techniques for AC Joint Dislocation

Tightrope vs. Hook Plate: Which is Best for AC Joint Dislocations?

Theo Raines in Health & Wellness July 2025 • 5 min read.

"A comparison of arthroscopic tightrope fixation and hook plate fixation for acute AC joint dislocations: weighing the benefits and risks."

Acromioclavicular joint (ACJ) separations, commonly known as shoulder separations, are frequent injuries, particularly among athletes and active individuals. These injuries occur when the ligaments connecting the collarbone (clavicle) to the shoulder blade (scapula) are damaged, leading to pain, instability, and limited range of motion. The severity of ACJ separations varies, with high-grade separations (types III-VI) representing complete dislocations that often require surgical intervention.

When surgery is needed, two modern techniques have become popular: hook plate fixation and coracoclavicular (CC) ligament fixation using a suspensory loop device, often referred to by the brand name Tightrope. Both methods aim to restore stability to the AC joint, but they differ significantly in their approach and potential outcomes. Hook plate fixation involves using a metal plate with a hook that anchors under the acromion (part of the scapula), while Tightrope fixation utilizes strong sutures to secure the clavicle to the coracoid process (another part of the scapula).

Given the ongoing debate about which technique yields the best results, a study was conducted to compare the short-term outcomes of arthroscopic Tightrope fixation with those of hook plate fixation in patients with acute unstable ACJ dislocations. This article will delve into the findings of this research, providing insights into the benefits and drawbacks of each surgical approach to help patients and healthcare professionals make informed decisions.

Tightrope Fixation vs. Hook Plate Fixation: Understanding the Surgical Techniques

Comparison of Tightrope and Hook Plate Surgical Techniques for AC Joint Dislocation

Arthroscopic Tightrope fixation is a minimally invasive procedure that involves creating small incisions around the shoulder joint. The surgeon then uses an arthroscope, a small camera, to visualize the joint and guide the placement of strong sutures between the clavicle and the coracoid process. These sutures act like a tightrope, pulling the clavicle back into its correct position and stabilizing the AC joint. This technique aims to restore the natural alignment of the joint while minimizing damage to surrounding tissues.

Hook plate fixation, on the other hand, involves a larger incision to expose the AC joint. A metal plate with a hook is then positioned over the clavicle, with the hook anchoring under the acromion. This provides rigid fixation of the AC joint, preventing movement and allowing the ligaments to heal. However, because of the larger incision and the presence of a metal implant, hook plate fixation is typically associated with more soft tissue damage and a higher risk of complications.

Arthroscopic Tightrope Fixation:
- Minimally invasive with smaller incisions.
- Uses strong sutures to stabilize the joint.
- Aims to restore natural joint alignment.
- Less damage to surrounding tissues.
Hook Plate Fixation:
- Involves a larger incision.
- Uses a metal plate with a hook for rigid fixation.
- Provides strong stabilization of the AC joint.
- More soft tissue damage compared to Tightrope fixation.

The study compared the outcomes of these two techniques in 26 patients with acute ACJ dislocations. 16 patients underwent arthroscopic Tightrope fixation, while 10 patients underwent hook plate fixation. The researchers collected data on various factors, including surgical time, postoperative shoulder function, pain levels, and complications.

Which Method is Right for You?

Ultimately, the choice between arthroscopic Tightrope fixation and hook plate fixation for acute ACJ dislocations depends on individual patient factors and surgeon preference. While the study suggests that Tightrope fixation may offer superior short-term outcomes, both techniques can be effective in restoring stability to the AC joint and improving shoulder function. Consulting with an experienced orthopedic surgeon is crucial to determine the most appropriate treatment plan based on the specific characteristics of your injury and your overall health status. Further research, including larger randomized controlled trials, is needed to provide more definitive evidence on the long-term outcomes of these two surgical approaches.

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Everything You Need To Know

What are the primary differences between Tightrope fixation and Hook Plate fixation for AC joint dislocations?

The main differences lie in the surgical approach and hardware used. Arthroscopic Tightrope fixation is minimally invasive, using strong sutures between the clavicle and coracoid process to stabilize the AC joint. It aims to restore natural joint alignment with smaller incisions. Hook plate fixation involves a larger incision and uses a metal plate with a hook that anchors under the acromion for rigid fixation. This method provides strong stabilization but is associated with more soft tissue damage. Further, Tightrope uses the coracoclavicular ligaments, and Hook Plate rely on the acromion, different parts of the scapula, for fixation.

For whom might Tightrope fixation be a more suitable option for AC joint separation?

Tightrope fixation may be more suitable for individuals seeking a minimally invasive procedure with less soft tissue damage. Given its aim to restore natural joint alignment using strong sutures between the clavicle and the coracoid process, it might be preferred by those keen on potentially faster recovery and reduced risk of complications associated with larger incisions and metal implants. However, the study suggests both Tightrope fixation and Hook Plate fixation can be effective, and a detailed consultation with an orthopedic surgeon is crucial for personalized recommendation.

What are the risks associated with Hook Plate fixation, and why might these risks occur?

Hook Plate fixation is associated with risks such as more soft tissue damage and a higher risk of complications due to the larger incision required to expose the AC joint and the presence of a metal implant. This increased tissue disruption can lead to infections, delayed healing, and potential irritation from the implant itself. It is important to note that the metal plate has a hook that anchors under the acromion, increasing soft tissue contact and the related complications.

How does Arthroscopic Tightrope fixation work to stabilize the AC joint after a dislocation?

Arthroscopic Tightrope fixation stabilizes the AC joint by using strong sutures placed between the clavicle and the coracoid process. The surgeon creates small incisions and uses an arthroscope to guide the placement of these sutures, which act like a tightrope, pulling the clavicle back into its correct anatomical position. This technique restores the natural alignment of the AC joint while minimizing damage to surrounding tissues and avoiding a large incision like in the Hook Plate fixation.

Given the short-term focus of the study, what are the outstanding questions regarding Tightrope fixation and Hook Plate fixation for AC joint dislocations?

Since the study focuses on short-term outcomes, outstanding questions remain about the long-term effectiveness and potential complications of both Tightrope fixation and Hook Plate fixation. Further research, including larger randomized controlled trials, is needed to determine which technique provides superior long-term stability, function, and patient satisfaction. Long-term studies are essential to evaluate issues such as suture failure in Tightrope fixation or hardware-related problems like hook impingement in Hook Plate fixation, and their impact on the need for revision surgeries and overall shoulder health. There is also the question of how these different approaches to restore the damaged ligaments connecting the collarbone (clavicle) to the shoulder blade (scapula) impact range of motion over a longer period of time.