Arthroscopic excision of sternoclavicular joint

Tavakkolizadeh, Adel; Hales, P. F.; Janes, Gregory C.

doi:10.1007/s00167-008-0692-x

Cited by 34 publications

(27 citation statements)

References 10 publications

(20 reference statements)

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“…A recent study using sternocleidomastoid tendon graft had promising clinical results and requires only superior to inferior drilling of the medial clavicle [27]. In addition, several studies have had good clinical outcomes for medial clavicle resection when instability is present in conjunction with osteoarthritis [15,17,23]. Tavakkolizadeh et al [23] described an arthroscopic medial clavicle resection with the perceived advantage of improved observation and minimized risk to mediastinal structures.…”

Section: Discussionmentioning

confidence: 99%

“…In addition, several studies have had good clinical outcomes for medial clavicle resection when instability is present in conjunction with osteoarthritis [15,17,23]. Tavakkolizadeh et al [23] described an arthroscopic medial clavicle resection with the perceived advantage of improved observation and minimized risk to mediastinal structures. Short-term followup appears promising for the arthroscopic procedure but, to our knowledge, there are no studies with minimum 2-year followup.…”

Section: Discussionmentioning

confidence: 99%

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Does Patient Sex Affect the Anatomic Relationships Between the Sternoclavicular Joint and Posterior Vascular Structures?

Merriman

Villacis

et al. 2014

Clinical Orthopaedics &Amp; Related Research

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Background Despite increased concern for injury during surgical reconstruction of the sternoclavicular joint, to our knowledge there are few studies detailing the vascular relationships adjacent to the joint. Questions/purposes We investigated sex differences in the following relationships for sternoclavicular joint reconstruction: (1) safe distance from the posterior surface of the medial clavicle's medial and lateral segments to the major vessels, (2) length of the first costal cartilage and safe distance from the first rib to the internal mammary artery, (3) minimum distance medial to the sternoclavicular joint for optimal hole placement, and (4) safe distance from the manubrium to the great vessels.Methods Fifty normal postcontrast CT scans of the chest were reviewed. Means, standard deviations, and 95% CI were calculated for each aforementioned measurement. A t-test was used to determine if a sex difference exists (p B 0.05).

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Does Patient Sex Affect the Anatomic Relationships Between the Sternoclavicular Joint and Posterior Vascular Structures?

Merriman

Villacis

et al. 2014

Clinical Orthopaedics &Amp; Related Research

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“…An arthroscopic approach for certain SCJ intraarticular pathologies could potentially decrease these risks. 3,4 This article describes an SCJ arthroscopic technique that has evolved over the past 5 years. The first procedures undertaken were diagnostic in 2 patients with an inflammatory monoarthropathy of the SCJ and a large effusion.…”

Section: Introductionmentioning

confidence: 99%

Arthroscopy of the Sternoclavicular Joint

Tytherleigh-Strong

2013

Arthroscopy Techniques

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Abstract:Traditionally, an open approach has been required to undertake any surgical intervention for intra-articular sternoclavicular joint pathology. This in itself carries a certain operative morbidity, including damage to the underlying mediastinal structures and damage to the sternoclavicular and costoclavicular ligaments, with subsequent joint instability and unsightly scarring. This technical note describes an arthroscopic approach to the sternoclavicular joint that reduces this morbidity. The evolution of the technique including the rationale for portal placement and the angle of instrument insertion is explained. Experience of over 50 arthroscopic procedures including diagnostic arthroscopy, discectomy, excision of loose bodies, and washout and debridement after infection and excision of the medial end of the clavicle for osteoarthritis is detailed.P athologic disorders around the sternoclavicular joint (SCJ) are rare, but symptoms can be debilitating, with limited treatment options. Traditionally, surgical intervention for SCJ disorders has required an open approach, which itself carries the risks of damage to the underlying mediastinal structures, instability, and scarring. 1,2 This in part has led to a high threshold for surgery. An arthroscopic approach for certain SCJ intraarticular pathologies could potentially decrease these risks. 3,4 This article describes an SCJ arthroscopic technique that has evolved over the past 5 years. The first procedures undertaken were diagnostic in 2 patients with an inflammatory monoarthropathy of the SCJ and a large effusion. In these patients we took an aspirate and synovial biopsy specimen. Subsequently, we have performed over 50 therapeutic procedures for intra-articular conditions including meniscectomy/discectomy for acute and chronic disk tears, excision of loose bodies, excision of the medial end of the clavicle for degenerative arthritis, and washout and debridement after infection. Surgical Technique Positioning and EquipmentThe procedure is performed with the patient under general anesthesia positioned supine. The patient's head is placed in a head ring, and a small sandbag is placed between the scapulae to open up the SCJs anteriorly. The operating surgeon stands on the operative side of the patient facing toward the head end of the table where the arthroscopic stack is positioned. A 2.7-mm arthroscope with a 3-mm cannula and trocar is used for visualization with the fluid pressure pump at 30 mm Hg. A mini-probe and punch with a mini-shaver using a 3.5-mm incisor blade and bur (Dyonics Smith & Nephew, Andover, MA) are used for instrumentation. A micro-bipolar VAPR radiofrequency probe (DePuy Mitek, Raynham, MA) is used for hemostasis and tissue ablation.Portal Placement Anatomic Considerations. The greatest perceived concerns surrounding SCJ surgery are the close proximity of the posteriorly lying mediastinal structures and damage to the anterior stabilizing structures. The potential advantage of an arthroscopic procedure is that once the arthroscope and ...

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“…As reported by Tavakkolizadeh et al 4 in 2009, 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, 5 SC joint arthroscopy has become a viable and, potentially, favorable modality for the treatment of symptomatic SC joint osteoarthritis in carefully selected patients.…”

mentioning

confidence: 99%

Arthroscopic Sternoclavicular Joint Resection Arthroplasty: A Technical Note and Illustrated Case Report

Warth

Lee

Campbell

et al. 2014

Arthroscopy Techniques

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Open resection arthroplasty of the sternoclavicular (SC) joint has historically provided good long-term results in patients with symptomatic osteoarthritis of the SC joint. However, the procedure is rarely performed because of the risk of injury to vital mediastinal structures and concern regarding postoperative joint instability. Arthroscopic decompression of the SC joint has therefore emerged as a potential treatment option because of many recognized advantages including minimal tissue dissection, maintenance of joint stability, avoidance of posterior SC joint dissection, expeditious recovery, and improved cosmesis. There are, however, safety concerns given the proximity of neurovascular structures. In this article we demonstrate a technique for arthroscopic SC joint resection arthroplasty in a 26-year-old active man with bilateral, painful, idiopathic degenerative SC joint osteoarthritis. This case also highlights the pearls and pitfalls of arthroscopic resection arthroplasty for the SC joint. There were no perioperative complications. Four months postoperatively, the patient had returned to full activities, including weightlifting, without pain or evidence of SC joint instability. One year postoperatively, the patient showed substantial improvements in the American Shoulder and Elbow Surgeons score; Single Assessment Numeric Evaluation score; Quick Disabilities of the Arm, Shoulder and Hand score; and Short Form 12 Physical Component Summary score over preoperative baseline values.

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Arthroscopic excision of sternoclavicular joint

Cited by 34 publications

References 10 publications

Does Patient Sex Affect the Anatomic Relationships Between the Sternoclavicular Joint and Posterior Vascular Structures?

Does Patient Sex Affect the Anatomic Relationships Between the Sternoclavicular Joint and Posterior Vascular Structures?

Arthroscopy of the Sternoclavicular Joint

Arthroscopic Sternoclavicular Joint Resection Arthroplasty: A Technical Note and Illustrated Case Report

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