Letter to the Editor: Chronic acromio-clavicular dislocation: Bi-modal stabilization.

This letter comments on the study by Mekky et al. on bi-modal stabilization for chronic acromioclavicular dislocation. We commend the authors for addressing both vertical and horizontal instability using a hybrid biologic-synthetic construct. We raise three issues that may affect interpretation of the findings: heterogeneity of surgical indications, the potential confounding effect of distal clavicle excision, and the lack of explicit criteria for defining recurrent instability or failure. Clarification of these points may improve the study's interpretability, reproducibility, and relevance for comparative evaluation of reconstructive strategies in chronic acromioclavicular instability.