http://orcid.org/0000-0003-1854-309X
Rockwood type III acromioclavicular (AC) joint dislocation represents a challenge and a common discussion on how to deal with them. Despite conservative treatment being accepted, surgical repairs may offer quicker outcomes and an early recovery.Citation1
However, within the surgical treatments, several options are nowadays available for repair of AC joint dislocation, with satisfactory outcomes.
The before mentioned study shows how the authors evaluate a treatment that aims to reduce surgical complications with two different techniques.Citation2–8
When examining an AC joint dislocation, careful attention must be paid to skin conditions, infections or neurovascular issues. During postoperative care, pain management, recovery ability, and return to play are important issue both for the physician and patient, as well as recurrence of dislocation and the need of second surgeries to remove osteosynthesis material.
However, beyond the strengths and weaknesses of every surgical technique, we would like to make a special comment on the need of evaluations or assessments.
It is always important to perform self-assessments, but it becomes essential in tough times, with an unfavorable economy, or when out patients have injuries that limit their health quality, with not only sport-related consequences, but with limited activities of daily living or work. Best treatment should be individualized to every patient reaching an agreement with the physician and according to the needs of every patient; time of sick leave, problems for daily life and sports-related activities. Specific tools should be available to aid us in explaining and opting for the best choice.
It is usual that patients with high demands or high-level sport for their shoulder, surgical treatment might be the best option, whereas patients with a more sedentary life can choose a conservative treatment.
Numerous studies have aimed to show the superiority of one treatment over the other. Over a thousand studies can be found in PubMed related to AC joint dislocation treatment.
The obligation to evaluate through functional outcomes, imaging studies and data collecting, allows us to compare not only which techniques can offer us advantages, but more important, they provide us with useful tools for self-assessment. The main error that surgeons can commit, is thinking that our outcomes are excellent and do not have improvement margin. A continuous self-assessment will allow us to improve having our feet on the ground, objectively observing if our work is not only good for our patients, but we will be able to compare with the remaining scientific community and evaluate acquiring or not therapies and techniques different to ours.
Digitalization of many clinical history systems makes easier this task, but it is our attitude that must always keep alert, not only with foreign techniques and therapies. Our first objective must always be performing our work with the best possible outcomes.
Therefore, we should systematically collect our outcomes and evaluate improvements in functional, pain and range of motion of our patients, in order to later compare them to other study groups.
Beyond a surgeon's self-satisfaction, the sense of honor towards our patients must exist, as well as towards our work colleagues. And, above all, we must be honest to ourselves and ask ourselves who is really who we are fighting to. The answer is almost always against us.
DECLARATION OF INTEREST
Each author certifies that he or she has no commercial associations (e.g., consultancies, stock ownership, equity interest, patent/licensing arrangements, etc.) that might pose a conflict of interest in connection with the submitted article.
REFERENCES
- Steinbacher G, Sallent A, Seijas R, Boffa JM, Espinosa W, Cugat R. Clavicular hook plate for grade-III acromioclavicular dislocation. J Orthop Surg (Hong Kong). 2014;22(3):329–32. doi:10.1177/230949901402200312.
- Cai L, Wang T, Lu D, Hu W, Hong J, Chen H. Comparison of the Tight Rope Technique and Clavicular Hook Plate for the Treatment of Rockwood Type III Acromioclavicular Joint Dislocation. J Invest Surg. 2018; 31(3):226–31. doi:10.1080/08941939.2017.1305022.
- Arirachakaran A, Boonard M, Piyapittayanun P, Kanchanatawan W, Chaijenkij K, Prommahachai A, Kongtharvonskul J. Post-operative outcomes and complications of suspensory loop fixation device versus hook plate in acute unstable acromioclavicular joint dislocation: a systematic review and meta-analysis. J Orthop Traumatol. 2017. doi:10.1007/s10195-017-0451-1.
- Cisneros LN, Reiriz JS. Management of acute unstable acromioclavicular joint injuries. Eur J Orthop Surg Traumatol. 2016;26(8):817–830. doi:10.1007/s00590-016-1836-1.
- Codsi M, Howe CR. Shoulder Conditions: Diagnosis and Treatment Guideline. Phys Med Rehabil Clin N Am. 2015;26(3):467–89. doi:10.1016/j.pmr.2015.04.007.
- Li Q, Hsueh PL, Chen YF. Coracoclavicular ligament reconstruction: a systematic review and a biomechanical study of a triple endobutton technique. Medicine (Baltimore). 2014;93(28):e193. doi:10.1097/MD.0000000000000193.
- Stucken C, Cohen SB. Management of acromioclavicular joint injuries. Orthop Clin North Am. 2015;46(1):57–66. doi:10.1016/j.ocl.2014.09.003.
- Cook JB, Tokish JM. Surgical management of acromioclavicular dislocations. Clin Sports Med. 2014;33(4):721–37. doi:10.1016/j.csm.2014.06.009.