Editorial Commentary: Drilling Is Never Easy Nor Without Danger in the Shoulder Region

Editorial Commentary: Drilling Is Never Easy Nor Without Danger in the Shoulder Region Jüri-Toomas Kartus, M.D., Ph.D., Associate Editor

Abstract: Drilling anatomic tunnels when performing coracoclavicular reconstruction might jeopardize the medial cortex of the coracoid process.

See related article on page 2012

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erforming reliable and sustainable coracoclavicular reconstruction has been a challenge. Therefore, the article in the present issue of Arthroscopy dealing with coracoclavicular reconstruction in a cadaver material is of specific interest. Shon, Choi, and Lim in their paper entitled “Anatomical Tunnel Placement Is Not Feasible by Transclavicular-Transcoracoid Drilling Technique for Coracoclavicular Reconstruction: A Cadaveric Study”1 conclude that “anatomical tunnel placement by transclavicular-transcoracoid drilling technique would not be feasible without breaching or almost breaching the medial cortex of the coracoid process.” Coracoclavicular reconstructions are getting increasingly popular both using suture tape2,3 and tendon grafts.4 They can be performed either with2 or without coracoid tunnels.4 If one chooses to use coracoid tunnels, then it is of uttermost importance that the tunnels are drilled safely without breaking the cortical bone of the coracoid. In view of this, the present study can give valuable information for surgeons performing these operations. Personally, I have been around long enough to have seen the challenge of getting a reliable result using the Weaver-Dunn technique5 as well as the complications

The author reports the following potential conflicts of interest or sources of funding: J-T.K. receives personal fees for lecturing from Linvatec Sweden. Full ICMJE author disclosure forms are available for this article online, as supplementary material. Ó 2018 by the Arthroscopy Association of North America 0749-8063/18173/$36.00 https://doi.org/10.1016/j.arthro.2018.02.009

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of using the Hook plate.6 It is therefore with great interest I see that more reliable methods are evolving and that these methods are critically reviewed as in the present study.

References 1. Koh KH, Shon MS, Choi NH, Lim TK. Anatomical tunnel placement is not feasible by transclavicular-transcoracoid drilling technique for coracoclavicular reconstruction: A cadaveric study. Arthroscopy 2018;34:2012-2017. 2. Shin SJ, Jeon YS, Kim RG. Arthroscopic-assisted coracoclavicular ligament reconstruction for acute acromioclavicular dislocation using 2 clavicular and 1 coracoid cortical fixation buttons with suture tapes. Arthroscopy 2017;33:1458-1466. 3. Triantafyllopoulos IK, Lampropoulou-Adamidou K, Schizas NP, Karadimas EV. Surgical treatment of acute type V acromioclavicular joint dislocations in professional athletes: An anatomic ligament reconstruction with synthetic implant augmentation. J Shoulder Elbow Surg 2017;26: e369-e375. 4. 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:e641-e648. 5. Weaver JK, Dunn HK. Treatment of acromioclavicular injuries, especially complete acromioclavicular separation. J Bone Joint Surg Am 1972;54:1187-1194. 6. Kienast B, Thietje R, Queitsch C, Gille J, Schulz AP, Meiners J. Mid-term results after operative treatment of Rockwood grade III-V acromioclavicular joint dislocations with an AC-hook-plate. Eur J Med Res 2011;16: 52-56.

Arthroscopy: The Journal of Arthroscopic and Related Surgery, Vol 34, No 7 (July), 2018: p 2018