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Letters to the Editor

Istanbul, Turkey

Dear Editor:

We read with interest the recent study from Nicholas et al, "Clinical Outcomes of Coracoclavicular Ligament Reconstructions Using Tendon Grafts" (November 2007, pages 1912–1917). Although there are some previous biomechanical and clinical studies that focus on coracoclavicular (CC) ligament reconstruction of the acromioclavicular (AC) joint, this study seems to be one of the earliest clinical trials assessing the results of 9 patients, to the best of our knowledge.

We have been routinely using a similar technique, anatomical double-bundle reconstruction with semitendinosus tendon autograft, in the treatment of type V acute and chronic AC joint separations since 2005. We agree with the authors’ conclusions; however, we have a concern related to their surgical technique. Based on some previous studies of various authors and our experience, we do not routinely perform distal clavicular excision for young patients.^1,2 We have had satisfying clinical results by preserving the normal bony anatomy of the AC joint and reconstructing the CC ligaments in patients without any clinical or radiological signs of arthritis. We keep excising the distal clavicle for older patients and for those who have painful, disabling, chronic AC separations with degenerative changes.

In the study of Nicholas et al, the average age of patients was given as 41 ± 12 years. Considering these data, some patients should be relatively young at the time of operation. We would like to ask the authors the reasons that led them to excise the distal clavicle in all cases, especially for acute cases.

The study of Nicholas et al is important and gives an excellent point of view about reconstructing CC ligaments, but we would like to emphasize that the decision about excision of the distal clavicle should be made considering the age of the individual patient and degenerative changes of the AC joint. We hope that we will learn much from future clinical trials that compare the results of CC ligament reconstruction without distal clavicular excision.

REFERENCES

1. Dlabach JA, Crockarel JR. Acromioclavicular joint. In: Canale ST, ed. Campbell’s Operative Orthopaedics. Philadelphia, Pa: Mosby; 2003:3178–3184.
2. Yoo JC, Choi NH, Kim SY, Kim TK. Distal clavicle tunnel widening after coracoclavicular ligament reconstruction with semitendinosis tendon: A case report. J Shoulder Elbow Surg. 2006;15:256–256.[CrossRef][ISI][Medline][Order article via Infotrieve]

Authors’ Response

New York, New York

Thank for your interest in our study. It has been our clinical experience that these patients go on to symptomatic AC joint arthritis regardless of age. As you noted, there is not much research on this issue, and clinicians must rely on their clinical experience. Clearly this needs to be studied prospectively.

This Article Full Text (PDF) Free Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Request Reprints Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Cilli, F. Articles by Tyler, T. F. Search for Related Content PubMed PubMed Citation Articles by Cilli, F. Articles by Tyler, T. F.