Subacromial osteolysis following hook plate fixation for acromioclavicular dislocation: a systematic review and meta-analysis

Background Clavicular hook plates are extensively used in the treatment of acromioclavicular (AC) dislocation. Subacromial osteolysis is a typical complication following hook plate fixation. We performed a systematic review and meta-analysis to determine the incidence of subacromial osteolysis and analyzed the associated characteristics of subacromial osteolysis to guide surgeons. Methods PubMed, EMBASE, and Cochrane Library databases were comprehensively searched for relevant literature. We screened the literature based on the eligibility criteria, extracted relevant data and assessed the quality of the included studies. Pooled odds ratios (ORs) or mean differences (MDs) with 95% confidence intervals were calculated by a fixed-effects or random-effects model. Heterogeneity was evaluated by the chi-squared test and I2 statistics. A meta-regression analysis was performed to explore the potential source of heterogeneity. Results Thirty-two studies met the inclusion criteria. The total pooled incidence of subacromial osteolysis was 29%, and the only covariate that could influence the incidence of subacromial osteolysis was the radiological measurement method (P=0.017). Patients in the hook plate fixation with coracoclavicular (CC) ligament reconstruction group had lower odds of subacromial osteolysis (OR, 2.54, 95% CI 1.54 to 4.18; P < 0.001). There were no significant differences in the Constant-Murley scores at the final follow-up between patients with and without subacromial osteolysis (SMD, −0.17; 95% CI, −0.50 to 0.15; P= 0.294). Conclusions Subacromial osteolysis has a relatively high and variable incidence, and the primary factor influencing the reported incidence is the radiological assessment method. The current analysis suggests CC ligament reconstruction as an effective surgical approach for decreasing the incidence of subacromial osteolysis. The presence or absence of subacromial osteolysis did not significantly impact the functional outcomes observed during the final follow-up period.