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Sternoclavicular Joint Reconstruction

March 15, 2015

Contributors: Michael Ryan, MD; Young W Kwon, MD, PhD, FAAOS; Maxwell Weinberg, MD; William Ryan, BS; Laith M Jazrawi, MD, FAAOS; Laith M Jazrawi, MD, FAAOS

BACKGROUND: Chronic sternoclavicular (SC) joint dislocation is a rare injury with a low-incidence of long-term dysfunction. Surgical reconstruction is, however, indicated in patients with chronic, symptomatic anterior instability, or with irreducible or recurrent posterior instability. Due to the strength of the posterior joint capsule, posterior dislocations rarely recur; and chronic anterior instability is typically benign. Therefore no established standard for SC joint reconstruction exists. Constructs using K-wire, Balser plate, suture anchor, and graft fixation have been described. Few investigators have reported more than several cases, and there is no consensus of technique for joint stabilization. We present a case and surgical technique of sternoclavicular joint reconstruction in a patient with chronic, symptomatic anterior instability using a tibialis anterior allograft in a figure-of-eight construct.

METHODS: Two 2.5mm unicortical holes are drilled along the lateral manubrium and medial clavicle. Tibialis anterior allograft whip-stitched with a strong, braided, non-absorbable suture. The graft is then passed in a pattern as to create a figure-of-eight. The SC joint is reduced and the graft is tensioned.

RESULTS: Due to the relative infrequency of symptomatic, chronic, anterior SC joint instability, little data exists comparing different methods of joint reconstruction. Previous studies have been limited by the use of heterogeneous outcome measures. However, in a biomechanical comparison of three different joint reconstructions in cadavers, Spencer and Kuhn , demonstrated that a semitendinosus figure-of-eight construct similar to the one used in this case, showed greater stability compared to intramedullary ligament and subclavius tendinosis constructs.

CONCLUSION: A review of clinical reports, suggests excellent outcomes with this technique when used in cases of chronic instability. However, due to the lack of standardization of SC joint reconstruction and the low incidence of joint dysfunction in effected patients, there is a lack of outcome data regarding this procedure.

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