Background Fixation of AC joint injuries with a hook plate provides a high strength construct and initial rotational mobility; however, it is associated with complications such as infection, implant failure, and osteolysis. Methods In accordance with PRISMA guidelines, PubMed, Embase, Web of Science, and Cochrane Library databases were searched in April 2023 for studies published after 2000. Studies were included if they examined hook plate fixation for AC joint injuries and associated complications, were prospective or retrospective studies, and were written in English. Studies that did not directly evaluate complications following hook plate fixation for AC joint injuries or had study designs that were systematic reviews, narrative reviews, conference abstracts, technical notes, letters to editors, or meta-analyses were excluded. Results The initial search identified 370 studies, 12 of which were included in this systematic review. Five studies were prospective, and seven were retrospective. Ten studies evaluated hook plate fixation without any augmentation or concomitant procedure. Two evaluated hook plate fixation augmented with ligament suturing or suture anchors. Following hook plate fixation, the most frequently cited complications across the 12 studies were subacromial osteolysis (4; 33.3%), loss of fixation (4; 33.3%), and infection (5; 41.7%). Subacromial osteolysis was more likely seen with hook plate fixation whereas loss of reduction and recurrence of deformity were more likely seen using other fixation techniques, such as tight rope. Conclusion Hook plate fixation for AC joint injuries is associated with high variation in subsequent complications. Common complications include subacromial osteolysis, loss of fixation, infection, and pain. Hook plate fixation augmented with coracoclavicular ligament tape or loop suspensory reconstruction may help lower rates of subacromial osteolysis and improve short-term functional outcome measures postoperatively. Both patients and surgeons should be aware of the complications that can occur with the use of hook plates for AC joint injuries.
Dave et al. (Wed,) studied this question.