Abstract
Instability of the sternoclavicular joint is most often anterior, but can be superior, and is either developmental in teen-agers or post-traumatic. Symptomatic cases have painful dislocations of the medial clavicle end when the arm is in abduction, extension, and outward rotation. The effect of non-surgical treatment is undocumented. Surgery is based on stabilization of the joint with a tendon graft (usually gracilis or semitendinosus). We prefer a technique by which the intra-articular disc is spared, which is also appropriate in young persons with an active epiphysis. The tendon is fixed to sternum in a drill tunnel and the clavicle is stabilized by a V-shaped reconstruction through two drill tunnels in the clavicle. The risk of re-instability after the procedure is about 15%.
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Further Reading
Biomechanical Studies
Spencer EE, Kuhn JE. Biomechanical analysis of reconstructions for sternoclavicular joint instability. J Bone Joint Surg Am. 2004;86(1):98–105.
Thomas DP, Williams PR, Hoddinott HC. A “safe” surgical technique for stabilization of the sternoclavicular joint: a cadaveric and clinical study. Ann R Coll Surg Engl. 2000;82(6):432–5.
Techniques with Semitendinosous Graft
Castropil W, Ramadan LB, Bitar AC, Schor B, de Oliveira D’Elia C. Sternoclavicular dislocation—reconstruction with semitendinosus tendon autograft: a case report. Knee Surg Sports Traumatol Arthrosc. 2008;16(9):865–8.
Guan JJ, Wolf BR. Reconstruction for anterior sternoclavicular joint dislocation and instability. J Shoulder Elb Surg. 2013;22(6):775–81.
Singer G, Ferlic P, Kraus T, Eberl R. Reconstruction of the sternoclavicular joint in active patients with the figure-of-eight technique using hamstrings. J Shoulder Elb Surg. 2013;22(1):64–9.
Tashjian RZ, Ross H, Granger E, Chalmers PN. Single loop allograft reconstruction for sternoclavicular joint instability. J Shoulder Elb Surg. 2020;15(4):719–23.
Techniques with Palmaris Longus or Gracilis Graft
Bak K, Fogh C. Reconstruction of the chronic anterior unstable sternoclavicular joint using a tendon autograft: medium-term to long-term follow-up results. J Shoulder Elb Surg. 2014;23(2):245–50.
Friedrich L, Afifi FK, Skarvan J, Friederich NF, Hirschmann MT. Combined gracilis tendon autograft reconstruction and discus repair of a chronic anterior-superior sternoclavicular joint dislocation. Knee Surg Sports Traumatol Arthrosc. 2012;20(1):1978–82.
Techniques with Sternocleidomastoideus
Armstrong AL, Dias JJ. Reconstruction for instability of the sternoclavicular joint using the tendon of the sternocleidomastoid muscle. J Bone Joint Surg Br. 2008;90(5):610–3.
Bae DS, Kocher MS, Waters PM, Micheli LM, Griffey M, Dichtel L. Chronic recurrent anterior sternoclavicular joint instability: results of surgical management. J Pediatr Orthop. 2006;26(1):71–4.
Techniques with Subclavius
Burrows HJ. Tenodesis of subclavius in the treatment of recurrent dislocation of the sterno-clavicular joint. J Bone Joint Surg Br. 1951;33(2):240–3.
Lunseth PA, Chapman KW, Frankel VH. Surgical treatment of chronic dislocations of the sterno-clavicular joint. J Bone Joint Surg Br. 1975;57(2):193–6.
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© 2023 The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd.
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Rathcke, M.W., Pedersen, T.H., Krogsgaard, M.R. (2023). Stabilization Procedures for Instability of the Sternoclavicular Joint. In: Lui, T.H. (eds) Arthroscopy and Endoscopy of the Shoulder. Springer, Singapore. https://doi.org/10.1007/978-981-19-7884-5_57
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DOI: https://doi.org/10.1007/978-981-19-7884-5_57
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