Clinical and Radiological Outcomes Following Endobutton–FiberWire Fixation for Acute Rockwood Type III and IV Acromioclavicular Joint Dislocations: A Prospective Observational Study

Background: Acromioclavicular (AC) joint dislocations are common shoulder injuries accounting for approximately 10–12% of all shoulder injuries and predominantly affect young, physically active individuals following high-energy trauma. Surgical management is recommended for unstable injuries; however, the optimal fixation technique remains controversial. Endobutton–FiberWire fixation has emerged as a reliable technique that provides stable anatomical coracoclavicular reconstruction with minimal implant-related complications.Objective: To evaluate the functional, radiological, and clinical outcomes of Endobutton–FiberWire fixation in patients with acute Rockwood type III and IV acromioclavicular joint dislocations.Materials and Methods: This prospective observational study included 35 consecutive patients aged 18–60 years with acute Rockwood type III and IV acromioclavicular joint dislocations treated with open reduction and Endobutton–FiberWire fixation at a tertiary care centre over 18 months. Functional outcomes were assessed using the Constant–Murley Score (CMS), Disabilities of the Arm, Shoulder and Hand (DASH) score, Visual Analogue Scale (VAS), and Specific Acromioclavicular Score (SACS). Radiological assessment included maintenance of reduction, implant position, and postoperative complications. Statistical analysis was performed using Student’s t-test, chi-square test, Pearson correlation analysis, and one-way ANOVA, with p<0.05 considered statistically significant.Results: The mean age of the patients was 41.2 ± 11.1 years. Patients with Rockwood type III injuries demonstrated superior functional outcomes compared with type IV injuries, with higher Constant–Murley scores (72.6 ± 8.92 vs. 66.8 ± 8.85), lower DASH scores (53.0 ± 14.93 vs. 60.0 ± 9.89), lower VAS pain scores (3.87 ± 1.85 vs. 4.90 ± 1.71), and lower SACS values (6.60 ± 1.72 vs. 7.25 ± 1.02). Anatomical reduction was successfully maintained in 34 of 35 patients (97.1%), while button migration occurred in one patient (2.9%). Rockwood classification demonstrated a significant association with postoperative functional outcomes (ANOVA: F = 10.7, p<0.001). Significant negative correlations were observed between Constant score and DASH score (r = –0.503, p = 0.002), VAS pain score (r = –0.450, p = 0.007), and SACS (r = –0.606, p<0.001).Conclusion: Endobutton–FiberWire fixation provides reliable anatomical reduction, favourable functional recovery, excellent radiological stability, and a low complication rate in patients with acute Rockwood type III and IV acromioclavicular joint dislocations. The technique represents a safe and effective method of coracoclavicular reconstruction that facilitates early rehabilitation and satisfactory clinical outcomes.