Biomechanical Comparison of Surgical Techniques for Resection Arthroplasty of the Sternoclavicular Joint

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Injuries of the sternoclavicular (SC) joint are rare and are usually caused by high-energy impacts experienced during sports or motor vehicle accidents. Symptomatic instability of the SC joint is best treated with surgical reconstruction. Painful posttraumatic osteoarthritis and degenerative conditions of the SC joint without instability can be successfully treated with resection arthroplasty. Discectomy in the early stages after a traumatic disc tear is a treatment option for patients with ongoing posttraumatic joint pain.

Diverse techniques of SC joint resection arthroplasty have been published, with varying amounts of medial clavicle resection ranging from a few millimeters up to 4 cm. A frequently used resection line runs oblique in relation to the SC joint from superolateral to inferomedial. Recently published arthroscopic SC joint resection techniques decompressed the SC joint with discectomy and resection of 6 to 10 mm of the medial end of the clavicle parallel to the joint line. Independent of the resection technique, most authors agree that preservation of ligamentous joint stability is essential for successful outcomes. Current anatomic and biomechanical stud- ies have suggested that minimizing bony resection may be advantageous for preservation of the joint stabilizers. Furthermore, it was observed that only the anteroinferior end of the medial clavicle is covered by articular cartilage and that the appearance and shape of the articular disc vary among patients. The authors of a recent anatomic investigation concluded that further studies are needed regarding the location and extent of medial clavicle resection necessary to adequately decompress the joint and maintain stability.

Therefore, the purpose of this study was to evaluate (1) if resection of the intra-articular disc alone can reliably decompress the SC joint and (2) if resection of the medial end of the clavicle parallel to the joint line decompresses the SC joint similar to the oblique resection technique. We hypothesized that resection of the intra-articular disc alone would not reliably decompress the SC joint and that the parallel joint-line resection technique would decompress the SC joint significantly more compared with the same amount of resection using the oblique technique.

Full Article: Biomechanical Comparison of Surgical Techniques for Resection Arthroplasty of the Sternoclavicular Joint

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