Percutaneous Knowles Pinning for Type V Acromioclavicular Joint Dislocation: An Alternative to Hook Plating

Background: Although various surgical techniques have been proposed in the literature for unstable acromioclavicular joint (ACJ) dislocation, there is no consensus on the best treatment for unstable ACJ dislocation. Forty-four percent of surgeons prefer to use hook plate insertion for ACJ injuries due to an easy and effective technique and good clinical outcomes. However, its potential complications, such as shoulder stiffness, shoulder impingement, and acromial erosion, have been the subject of constant concern. Objectives: The purpose of our study is to compare the results of open reduction with hook plate fixation versus closed reduction with percutaneous Knowles pin fixation for the treatment of type V ACJ dislocation to demonstrate that percutaneous Knowles pinning is an alternative to hook plating. Materials and Methods: A single-institution retrospective study was conducted to analyze 87 patients with acute type V ACJ dislocation who had received hook plate fixation (H group) or percutaneous Knowles pin fixation (K group) from February 2013 to October 2020. The clinical results, radiological evaluation, and postoperative complications of the patients after surgery were collected by reviewing medical and operative records and radiographs. Results: The K group (33 patients) had equally satisfactory effects on the Constant-Murley shoulder score compared to the H group (54 patients). In the two groups, the K group had significantly shorter in wound length, operation time, and duration of hospitalization. Furthermore, the postoperative complication rate was significantly lower in the K group. Conclusions: Percutaneous Knowles pinning presents a cost-effective surgical method for acute type V ACJ dislocation compared to hook plating. We believe it is an available therapy option that can reduce patient suffering and minimize medical costs, serving as an alternative to hook plating.