Symptomatic osteoarthritis of the sternoclavicular (SC) joint is an uncommon pathology that can produce significant pain and disability in some patients. Although conservative management typically results in symptomatic improvement, a small subset of patients will have recalcitrant pain and continued shoulder disability. Surgical management is therefore indicated after a course of nonoperative therapy fails to provide symptomatic relief.
Traditionally, open resection arthroplasty of the SC joint has been the treatment of choice in patients with intractable pain and dysfunction as a result of SC joint osteoarthritis. Good to excellent outcomes have been reported after open resection arthroplasty in several series1-3; however, an open approach to the SC joint requires some posterior dissection, potentially placing vital mediastinal structures at risk. In addition, over- resection of the medial clavicle with a large capsulotomy may lead to postoperative instability because of the need for intraoperative ligament detachment.
As reported by Tavakkolizadeh, arthroscopy of the SC joint was originally thought to enhance patient outcomes by improving visualization, minimizing surgical trauma, limiting the risk to vital retrosternal structures, avoiding postoperative instability, and hastening recovery times while also improving cosmesis. Because of these advantages and with the addition of new encouraging outcomes data, SC joint arthroscopy has become a viable and, potentially, favorable modality for the treatment of symptomatic SC joint osteoarthritis in carefully selected patients. However, very few orthopaedic surgeons or arthroscopists have experience with the technique.
Therefore the purposes of this article are (1) to describe pertinent arthroscopic anatomy related to the SC joint, (2) to present and demonstrate a technique for arthroscopic SC joint resection arthroplasty, and (3) to illustrate a case in which bilateral SC joint decompressions were necessary in a young, active patient with symptomatic degenerative osteoarthritis of the SC joint.