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Hamstring Autograft Reconstruction for Management of Irreducible Anterior Sternoclavicular Joint Dislocations

March 01, 2019

Contributors: Costas Bizekis; Isabella Brooke Jazrawi; Young W Kwon, MD, PhD, FAAOS; Dylan Lowe, MD; Theodore S. Wolfson, BS; Theodore S. Wolfson, BS

Acute sternoclavicular (SC) joint injuries are rare, accounting for only 1% to 3% of all shoulder girdle injuries. SC joint injuries usually result from high-energy trauma and are associated with potentially serious complications because of their proximity to the hilar structures. Although the SC articulation is inherently unstable, allowing motion in all planes, it is stabilized by a robust ligamentous complex. Closed reduction and nonsurgical management of acute SC joint dislocations may be attempted; however, caution should be exercised given the potential for serious complications. Surgical fixation for the management of irreducible or unstable SC joint dislocations has been performed via a variety of reconstruction and fixation techniques. Historical techniques have been limited by hardware complications, graft failure, and residual or recurrent instability. Modern techniques involve graft reconstruction of the SC joint, which results in excellent biomechanical stability and consistent, durable clinical outcomes. This video demonstrates SC joint reconstruction via open reduction and stabilization with a semitendinosus autograft secured in a transosseous figure-of-eight configuration. The video provides a brief overview of the anatomy, diagnosis, and management of acute SC joint dislocations followed by a discussion of the surgical considerations and indications for hamstring autograft reconstruction. The video discusses the case presentation of a 22-year-old male hockey player who sustained an acute, irreducible SC joint dislocation. Open reduction and reconstruction using a semitendinosus autograft is demonstrated in the video, with illustrations provided to orient and guide the viewer. Excellent reduction and fixation was obtained intraoperatively, and excellent postoperative clinical outcomes were achieved, with maintenance of reduction and return to sports activity. SC joint reconstruction is a safe and reliable option for the management of acute SC joint dislocations in active, healthy patients. Careful technique is critical to avoid pitfalls and ensure consistent outcomes.