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

Abstract

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.

Arthroscopic Intra-articular Disk Excision of the Sternoclavicular Joint

“…1 Arthroscopic excision of the SCJ has been reported by a number of authors with no reported complications and no cases of instability. 8,10,18 Arthroscopic intra-articular disk excision of the SCJ is a safe and reproducible procedure. It has the advantage over an open procedure of not having to undertake a formal capsulotomy with the required capsular repair, subsequent period of immobilization, and risk of potential instability.…”

“…3,[5][6][7] However, advances in routine computed tomographic (CT) and MRI imaging and the advent of arthroscopic sternoclavicular surgery may allow for easier diagnosis and treatment of symptomatic disk tears. [8][9][10] This Technical Note describes the diagnosis and arthroscopic surgical technique for the management of symptomatic SCJ intra-articular disk tears.…”

Swellings of the sternoclavicular joint: review of traumatic and non-traumatic pathologies

“…Capsular tissue that is inferior and lateral to the anterior capsular ligament is relatively patulous and has been described as a preferred location for intra-articular injections and arthroscopic portal placement. 158 Both Tavakkolizadeh et al 157 and Warth et al 101 have reported satisfactory outcomes in their patients following therapeutic SCJ arthroscopy.…”

“… 96 , 97 Surgery is only reserved for those with intractable pain. Case series have been published discussing various surgical modalities including excision 62 , 97 , 98 with or without reconstruction of the sternoclavicular ligaments with graft material, 46 arthroscopic procedures 99 – 101 and interpositional arthroplasty. 93 Poor results can be associated with workers’ compensation patients.…”

“…The case series of 10 patients with SCJ osteoarthritis treated with arthroscopic medial clavicle excision by Tytherleigh-Strong et al 100 reported no complications and no cases of postoperative instability. Warth et al 101 in their article conclude that arthroscopic SCJ decompression can be a safe and effective treatment method for symptomatic SCJ osteoarthritis when performed by experienced surgeons who are familiar with the unique anatomy of the region and when the surgery is performed at a high-volume SC referral centre with cardiothoracic backup. They recommend that since arthroscopy of the SCJ is an uncommon procedure it should not be performed by inexperienced surgeons.…”