Radiographic displacement of acute acromioclavicular joint dislocations fixed with AC TightRope Anell Olivos-Meza, PhD, Arturo Almaz  an-Diaz, MD, Jos  e Alberto Calvo, MD, C  esar Alejandro Jim  enez-Aroche, MD, Marco Vinicio Valdez-Ch  avez, MD, Francisco P  erez-Jim  enez, MD, Clemente Ibarra, PhD, Francisco Cruz-L  opez, MD * Orthopedic Sports Medicine, Instituto Nacional de Rehabilitaci on Luis Guillermo Ibarra Ibarra, Mexico City, Mexico article info Keywords: Acromioclavicular joint dislocation acromioclavicular joint reduction arthroscopic fixation TightRope device radiologic displacement functional outcomes Level of evidence: Level IV; Case Series; Treatment Study Background: The arthroscopic approach to acromioclavicular (AC) dislocation with methods such as AC TightRope fixation has reported radiographic failure rates between 18% and 50% with functional results graded as good or excellent. Our objective was to review the outcomes after arthroscopic fixation for acute AC joint dislocation using the TightRope device. Methods: We reviewed the records of 52 patients, with a mean age of 31 years, who underwent arthroscopic fixation with the TightRope device for acute AC joint dislocation. Outcomes were evaluated using the Constant and University of California, Los Angeles scores. The coracoclavicular (CC) distance before and after surgery was compared by radiography. Results: The mean follow-up period was 36.7 months (range, 6-65 months). Postoperatively, the mean Constant score was 97.13 and the mean University of California, Los Angeles score was 33.2. The CC distance was maintained in 73% of the patients, whereas partial loss of reduction occurred in 19.2% and failure of reduction occurred in 7.7%. Conclusion: Arthroscopic fixation using the TightRope device for acute AC joint dislocation achieves satisfactory clinical outcomes. However, CC reconstruction appears to result in subluxation in cases with AC dislocation for a period of more than 10 days. © 2019 Published by Elsevier Inc. on behalf of American Shoulder and Elbow Surgeons. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/). Approximately 12% of shoulder injuries involve damage to the acromioclavicular (AC) joint, with many of these injuries being underdiagnosed. 6 Forty-three percent occur in adults who practice high-impact sports such as football, rugby, or hockey. 4, 11, 12, 19 More than 60 procedures have been described for the surgical management of AC dislocations; however, none is considered the gold standard. 1, 14 There is controversy in the management of this lesion, especially with a type III dislocation; some schools prefer conservative treatment over surgical treatment. 8, 17, 18 Multiple novel procedures have been developed with the objective of reconstructing the joint in an anatomic form, repro- ducing the coracoclavicular (CC) ligaments with allograft and autograft. 7, 16,22 Studies have reported improvement in biome- chanical strength with these techniques; however, there are no studies showing improvement in clinical outcomes. 9, 15 Some arthroscopic techniques involve reconstruction using devices such as the TightRope device (Arthrex, Naples, FL, USA), designed to stabilize the AC joint with a nonrigid fixation. These techniques are used in acute cases with the aim to repair the ligaments, perios- teum, and AC capsule and maintain clavicle reduction. 13,23,25 Arthroscopic management of these dislocations stabilized with the TightRope device in acute cases allows one to perform a minimally invasive, nonrigid procedure that re-creates the CC lig- aments to maintain the reduction temporally and permit the repair of the AC joint ligaments. 23 According to a biomechanical study by Walz et al, 25 the vertical force required for this system to fail is 982 N whereas the force required for native ligaments to fail is 598 N. There is little literature showing the clinical and radiologic results of these techniques in the short, medium, and long term, and the published studies are case series with very small study populations. The aim of this study was to review the outcomes after arthroscopic fixation for acute AC joint dislocation using the TightRope device. Materials and methods A retrospective, descriptive, transverse study of patients with acute AC dislocation of grade III, IV, or V (according to the Institutional review board approval was received from Instituto Nacional de Rehabilitaci on Luis Guillermo Ibarra Ibarra. * Corresponding author: Francisco Cruz-L opez, MD, Orthopedic Sports Medicine, Instituto Nacional de Rehabilitaci on Luis Guillermo Ibarra Ibarra, Calzada Mexico- Xochimilco 289, ZC 14389, Mexico City, Mexico. E-mail address: hombro2000@gmail.com (F. Cruz-L opez). Contents lists available at ScienceDirect JSES International journal homepage: www.jsesinternational.org https://doi.org/10.1016/j.jseint.2019.11.002 2666-6383/© 2019 Published by Elsevier Inc. on behalf of American Shoulder and Elbow Surgeons. This is an open access article under the CC BY-NC-ND license (http:// creativecommons.org/licenses/by-nc-nd/4.0/). JSES International 4 (2020) 49e54