Clinical outcomes after autograft reconstruction for sternoclavicular joint instability

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 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.

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

Peter Millett, MD

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39 reviews

Alexandra Thompson

Mar 23, 2024

by Alexandra Thompson on Peter Millett, MD

110%

Dr. Millett and his team did a SLAP tear repair and bicep tenodesis on my left shoulder. I use my arms as an artist, and love to swim in the ocean, surf, paddle, and telemark ski. So regaining full use of my shoulder and keeping my bicep attached was very important to me. Now, over two years later, my shoulder has the equivalent range of motion as my other arm and as before the injury, and no pain. After the first three months it felt so good and was so strong that - to my horror - I completely forgot my six-month follow-up.

Not only did Dr. Millett and his team make my arm as good as new, but having had the experience of such kindness and expertise throughout the process of surgery and recovery is like an added shoulder superpower.

Thank you Rita, Brooke, Jason, Sarah, Camille, Olivia, Dr. Millett and everyone! And see you soon when my husband comes in for his knee...

Jeff Chandler

Jan 31, 2022

by Jeff Chandler on Peter Millett, MD

Flawless procedure, Easy recovery

Dr. Millet's repaired my knee and tibia, following a botched operation by a different surgeon. That procedure was virtually pain free and I was weight bearing within a few days. That was 18 years ago and the knee is still strong. A few years after the knee incident, Dr Millet repaired my shoulder. My insurance company approved me for 3 months of disability following that surgery. I was off pain medication in 2 days and had 90% range of motion within a week. I withdrew my disability claim and returned to work within two weeks of surgery. I’m not a famous athlete—just a regular guy. Nonetheless, I was treated like an NFL at the Steadman clinic. Most notable was the time for recovery. Other surgeons perform their hour-long task in the OR and don’t involve themselves in the other functions. Peter and his team manages the entire process from diagnosis, anesthesia, nursing care, and therapy. He takes a holistic approach to patient care and doesn’t skip any steps.

Jenn West

Jul 2, 2021

by Jenn West on Peter Millett, MD

Saved My Life

I went to Dr. Millett after 7 knee surgeries (6 on my right and 1 on my left) and had seen 11 different surgeons who all refused to remove femur metal from my right leg. I am highly allergic to metal and the chronic pain was leaving me bedridden for 3.5wks out of a month. He personally wrote me back on my inquiry, listened to my concerns, scheduled my surgery within a week (due to insurance issues) and personally followed up with my recovery. The level of patient care from Dr. Millett and his ENTIRE team is above any care I have ever received in my 20 years of dealing with orthopedic surgeons. There are not enough words to describe the level of care, dedication and professionalism you receive from Dr. Millett and his staff.
My only disappointment is that I did not find him sooner!!!

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Clinical outcomes after autograft reconstruction for sternoclavicular joint instability

About the Author: Peter Millett, MD