Clinical outcomes after autograft reconstruction for sternoclavicular joint instability

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Sternoclavicular (SC) joint stability relies on the presence of intact capsular, costoclavicular and interclavicular ligaments. Direct or indirect high-energy trauma is most often responsible for disruption of SC joint–stabilizing structures, thereby resulting in anterior or posterior dislocation or subluxation. Injuries to the SC joint are rare and account for only 3% of all shoulder girdle injuries and 1% of all dislocations, making it one of the least commonly disrupted joints in the body. In contrast to anterior dislocations, posterior dislocations are less common and represent potentially life-threatening injuries. Locked posterior dislocations require emergency surgical treatment due to potential for injury of the retrosternal structures such as major vessels, the trachea, esophagus and mediastinum. Most anterior dislocations are treated nonsurgically with minimal risk for long-term sequelae ; however, pain resulting from SC instability or post-traumatic osteoarthritis may lead to discomfort and limit functional activities. Surgical treatment may therefore be necessary in patients with persistent, symptomatic SC joint instability despite appropriate nonsurgical measures.

Numerous techniques are available for reconstruction of the SC joint, but many of these procedures are associated with high complication rates. A current gold standard for reconstruction of the SC joint does not exist. Surgical treatment options require deep dissection of the SC joint, putting at risk the adjacent structures such as the trachea, the brachiocephalic vein, the brachiocephalic trunk, the subclavian artery, and the common carotid artery. Therefore, an intimate knowledge of the surrounding anatomy and anatomic relationships is crucial before an SC joint reconstruction is performed to prevent potentially life-threatening complications from occurring.

A biomechanical study conducted by Spencer and Kuhn suggested that SC joint reconstruction using graft material oriented in a figure-of-eight fashion with 2 drill holes in the clavicle and 2 in the sternum was superior to other methods when comparing graft integrity, load to failure, and translation of the medial clavicle. However, in the case where a proximal clavicle excision has been done previously, establishing 2 drill tunnels in the clavicle may not be possible. In this setting, a single-looped reconstruction can be performed. The hypothesis of this study was that patients with persistent symptomatic SC joint instability reconstructed with a hamstring tendon autograft would demonstrate good clinical outcomes with high patient satisfaction and a low complication rate.

Full Article: Clinical outcomes after autograft reconstruction for sternoclavicular joint instability