Abstract
Purpose
Publications describing tendon graft reconstruction for anterior sternoclavicular joint (SCJ) instability are rare and usually refer to small patient numbers. The aim of this study was to systematically review the literature regarding outcomes and complications following tendon graft reconstruction techniques for anterior SCJ instability.
Methods
An online database was systematically searched to identify studies on graft reconstruction for anterior SCJ instability. Reported outcome scores were graded as excellent, good, fair and poor to summarize the study results. All reported complications were recorded.
Results
Five articles with a total of 80 patients met the inclusion criteria. Reported outcomes were excellent in 10 %, good in 89 % and fair in 1 %. Recurrent instability was found in 10 % of the patients, and 5 % underwent revision surgery due to persistent impairment of shoulder function related to SCJ instability or osteoarthritis.
Conclusion
Surgical stabilization techniques for the SCJ using autologous tendon grafts have shown to be safe and reliable and make better patients’ pain situation and shoulder function. However, a certain amount of impairment might persist, which needs to be discussed with patients. Severe complications were rare and revision rates were as low as 5 %. Therefore, graft reconstruction techniques should be considered for patients with chronic anterior SCJ instability after a course of failed conservative treatment. This study is valuable for clinicians in daily clinical practice when dealing with this difficult-to-treat pathology and can help surgeons to better predict the clinical outcomes and complications following SCJ graft reconstruction. It should, however, not lead to underestimation of the potential risks of the procedure.
Level of evidence
Systematic review, Level IV.
Similar content being viewed by others
References
Abiddin Z, Sinopidis C, Grocock CJ, Yin Q, Frostick SP (2006) Suture anchors for treatment of sternoclavicular joint instability. J Shoulder Elbow Surg 15(3):315–318
Acus RW 3rd, Bell RH, Fisher DL (1995) Proximal clavicle excision: an analysis of results. J Shoulder Elbow Surg 4(3):182–187
Armstrong AL, Dias JJ (2008) Reconstruction for instability of the sternoclavicular joint using the tendon of the sternocleidomastoid muscle. J Bone Joint Surg Br 90(5):610–613
Asplund C, Pollard ME (2004) Posterior sternoclavicular joint dislocation in a wrestler. Mil Med 169(2):134–136
Bae DS, Kocher MS, Waters PM, Micheli LM, Griffey M, Dichtel L (2006) Chronic recurrent anterior sternoclavicular joint instability: results of surgical management. J Pediatr Orthop 26(1):71–74
Bak K, Fogh K (2014) Reconstruction of the chronic anterior unstable sternoclavicular joint using a tendon autograft: medium-term to long-term follow-up results. J Shoulder Elbow Surg 23(2):245–250
Bensafi H, Laffosse JM, Taam SA, Molinier F, Chaminade B, Puget J (2010) Tamponade following sternoclavicular dislocation surgical fixation. Orthop Traumatol Surg Res 96(3):314–318
Clark RL, Milgram JW, Yawn DH (1974) Fatal aortic perforation and cardiac tamponade due to a Kirschner wire migrating from the right sternoclavicular joint. South Med J 67(3):316–318
de Jong KP, Sukul DM (1990) Anterior sternoclavicular dislocation: a long-term follow-up study. J Orthop Trauma 4(4):420–423
Dennis MG, Kummer FJ, Zuckerman JD (2000) Dislocations of the sternoclavicular joint. Bull Hosp Jt Dis 59(3):153–157
Dutta AK, Wirth MA, Rockwood CA (2009) Sternoclavicular Joint Injuries. In: Buchholz RW, Court-Brown CM, Heckman JD, Tornetta P III (eds) Rockwood and green’s fractures in adults, 7th edn. Lippincott Williams and Wilkins, Philadelphia, pp 1243–1271
Eskola A, Vainionpaa S, Vastamaki M, Slatis P, Rokkanen P (1989) Operation for old sternoclavicular dislocation. Results in 12 cases. J Bone Joint Surg Br 71(1):63–65
Franck WM, Jannasch O, Siassi M, Hennig FF (2003) Balser plate stabilization: an alternate therapy for traumatic sternoclavicular instability. J Shoulder Elbow Surg 12(3):276–281
Groh GI, Wirth MA (2011) Management of traumatic sternoclavicular joint injuries. J Am Acad Orthop Surg 19(1):1–7
Guan JJ, Wolf BR (2013) Reconstruction for anterior sternoclavicular joint dislocation and instability. J Shoulder Elbow Surg 22(6):775–781
Lee SU, Park IJ, Kim YD, Kim YC, Jeong C (2010) Stabilization for chronic sternoclavicular joint instability. Knee Surg Sports Traumatol Arthrosc 18(12):1795–1797
Lemos MJ, Tolo ET (2003) Complications of the treatment of the acromioclavicular and sternoclavicular joint injuries, including instability. Clin Sports Med 22(2):371–385
Martetschläger F, Braun S, Lorenz S, Lenich A, Imhoff AB (2015) Novel technique for sternoclavicular joint reconstruction using a gracilis tendon autograft. Knee Surg Sports Traumatol Arthrosc. doi:10.1007/s00167-015-3570-3
Martetschläger F, Imhoff AB (2014) Surgical stabilization of acute/chronic sternoclavicular instability with autologous gracilis tendon graft. Oper Orthop Traumatol 26(3):218–227
Martetschläger F, Warth RJ, Millett PJ (2014) Instability and degenerative arthritis of the sternoclavicular joint: a current concepts review. Am J Sports Med 42(4):999–1007
Rajaratnam S, Kerins M, Apthorp L (2002) Posterior dislocation of the sternoclavicular joint: a case report and review of the clinical anatomy of the region. Clin Anat 15(2):108–111
Renfree KJ, Wright TW (2003) Anatomy and biomechanics of the acromioclavicular and sternoclavicular joints. Clin Sports Med 22(2):219–237
Robinson CM, Jenkins PJ, Markham PE, Beggs I (2008) Disorders of the sternoclavicular joint. J Bone Joint Surg Br 90(6):685–696
Rockwood CA Jr, Odor JM (1989) Spontaneous atraumatic anterior subluxation of the sternoclavicular joint. J Bone Joint Surg Am 71(9):1280–1288
Singer G, Ferlic P, Kraus T, Eberl R (2013) Reconstruction of the sternoclavicular joint in active patients with the figure-of-eight technique using hamstrings. J Shoulder Elbow Surg 22(1):64–69
Smolle-Juettner FM, Hofer PH, Pinter H, Friehs G, Szyskowitz R (1992) Intracardiac malpositioning of a sternoclavicular fixation wire. J Orthop Trauma 6(1):102–105
Spencer EE, Jr., Kuhn JE (2004) Biomechanical analysis of reconstructions for sternoclavicular joint instability. J Bone Joint Surg Am 86-A (1):98-105
Spencer EE, Wirth MA, Rockwood CA (2007) Disorders of the Sternoclavicular Joint: Pathophysiology, Diagnosis and Management. In: Iannotti JP, Williams GR (eds) Disorders of the shoulder: diagnosis and management, 2nd edn. Lippincott Williams and Wilkins, Philadelphia, pp 1007–1054
Uri O, Barmpagiannis K, Higgs D, Falworth M, Alexander S, Lambert SM (2014) Clinical outcome after reconstruction for sternoclavicular joint instability using a sternocleidomastoid tendon graft. J Bone Joint Surg Am 96(5):417–422
Wirth MA, Rockwood CA (2009) Disorders of the sternoclavicular joint. In: Rockwood CA Jr, Matsen FA III, Wirth MA, Lippitt SB (eds) The shoulder, 4th edn. Saunders, Philadelphia, pp 527–560
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors declare that they have no conflict of interest.
Additional information
Lukas Willinger and Jakob Schanda have equally contributed to this work.
Rights and permissions
About this article
Cite this article
Willinger, L., Schanda, J., Herbst, E. et al. Outcomes and complications following graft reconstruction for anterior sternoclavicular joint instability. Knee Surg Sports Traumatol Arthrosc 24, 3863–3869 (2016). https://doi.org/10.1007/s00167-015-3770-x
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00167-015-3770-x