The growing need of patients to recover full ability quickly explains the popularity of operative treatments for trauma injuries of many parts of the locomotor system. This need is understandable, especially at the peak of life and career activities. Producers of implants used in everyday orthopedic and traumatologic practice meet this demand. Unfortunately, the proposed stabilization methods of the disruption of tissue continuity or the reconstruction of the bony tissue loss and especially of the damaged soft tissues are often based on static mechanical studies that do not take into account the complexity or the specificity of individual patients [Citation1–3]. Therefore, it is all the more crucial to work out strict recommendation criteria for the industry-proposed implants. The details of operative techniques need to be elaborated through practical knowledge. Surgical interventions need to be, above all, safe for patients and surgical trauma is limited to such an extent that its effects do not influence negatively the expected performance.
The operative treatment of acromioclavicular joint dislocations has a longstanding history [Citation4]. The initial interest in effective operative repairs was primarily due to the need to alleviate the long-term pain in the area as well as to remove the cosmetic defect dominating over the shoulder line because of the dislocation of the distal clavicular end. Initially, less attention was paid to the consequences in activity function of the dislocated clavicula or to the over-stiffening of the undertaken repairs for the whole shoulder complex. The treatment method of dynamic reconstruction of the damaged coracoclavicular ligaments, presented in the paper “Position of coracoid button predicts loss of reduction in acromioclavicular joint dislocation patients treated with the suture-button,” fulfills contemporary expectations pertaining to repairs of acromioclavicular joint dislocations [Citation5]. The value of this study lies not only in the underlined positive sides of the method, but most of all, in the open presentation of the failures and the analysis of their causes. The authors critically evaluate the outcomes of their repairs and search for the reasons of the loss of the initially good functional outcomes in the form of instability with all its consequences. The results presented in many publications amount for the most part to descriptions of physical ability of the operated limbs without paying special attention to groups of patients whose results were poor or bad [Citation6, Citation7]. However, based on the presented research, the use of the endobutton technique proves to be important with the course of the bone canals in the coracoid and the clavicle. A detailed and technical description of the method and location of placement of the endobutton plates is particularly significant in everyday traumatological practice. It allows for the prevention of failures for therapeutical teams that yield to commercially offered demonstrations of operative techniques.
Hence, the paper entitled “Position of coracoid button predicts loss of reduction in acromioclavicular joint dislocation patients treated with the suture-button,” (apart from its research merit), has primarily the value of practical information for every orthopedic–traumatologist that deals with treatment problems of trauma and its consequences in the shoulder area.
DECLARATION OF INTERESTS
The author has no competing interests to declare.
References
- Nuzzo MS, Adamson GJ, Lee TQ, McGarry MH, Husak L. Biomechanical comparison of fracture risk created by 2 different clavicle tunnel preparations for coracoclavicular ligament reconstruction. Orthop J Sports Med. 2014;2(11):232596711455547. doi:https://doi.org/10.1177/2325967114555478.
- Moya D, Poitevin LA, Postan D, et al. The medial coracoclavicular ligament: anatomy, biomechanics, and clinical relevance—a research study. JSES Open Access. 2018;2(4):183–189. doi:https://doi.org/10.1016/j.jses.2018.07.001.
- Banffy MB, Uquillas C, Neumann JA, ElAttrache NS. Biomechanical evaluation of a single- versus double-tunnel coracoclavicular ligament reconstruction with acromioclavicular stabilization for acromioclavicular joint injuries. Am J Sports Med. 2018;46(5):1070–1076. doi:https://doi.org/10.1177/0363546517752673.
- Spencer E. Treatment of grade III acromioclavicular joint injuries: a systematic review. Clin Orthop Relat Res. 2007;455:38–44. doi:https://doi.org/10.1097/BLO.0b013e318030df83.
- UIVS-2018-0731
- Cook JB, Shaha JS, Rowles DJ, Bottoni CR, Shaha SH, Tokish JM. Clavicular bone tunnel malposition leads to early failures in coracoclavicular ligament reconstructions. Am J Sports Med. 2013;41(1):142–148. doi:https://doi.org/10.1177/0363546512465591.
- Chernchujit B, Parate P. Surgical technique for arthroscopy-assisted anatomical reconstruction of acromioclavicular and coracoclavicular ligaments using autologous hamstring graft in chronic acromioclavicular joint dislocations. Arthrosc Tech. 2017;6(3):e641–e648. doi:https://doi.org/10.1016/j.eats.2017.01.009.