Chronic Instability and Pain of the Sternoclavicular Joint: Treatment With Semitendinosus Allograft to Restore Joint Stability

Abstract

Chronic instability of the sternoclavicular (SC) joint is a challenging clinical problem, particularly in a patient population for which nonoperative forms of treatment prove ineffective. Patients present after experiencing recurrent subluxation events and subsequent pain, which commonly result in increasing functional limitation. Recurrent SC joint instability of this nature can lead to damage of the SC joint cartilage and bone, and in cases of posterior subluxation or dislocation, damage to mediastinal structures. While the precise treatment algorithm requires tailoring to individual patients and their respective pathologies, we have demonstrated successful outcomes in correcting chronic SC joint instability by means of SC joint reconstruction with semitendinosus allograft, SC joint capsular reconstruction, and, in cases of arthritic damage, resection of a small portion of the degenerative component of the medial clavicle. The purpose of this Technical Note is to describe a technique that uses a semitendinosus allograft to stabilize the SC joint combined with a capsular reconstruction in patients who have previously failed nonoperative treatment methods.

Sternoclavicular Joint Reconstruction for Medial Clavicle Fracture Nonunion

“…This technique has been validated in both cadaveric and in vivo studies. 3,[7][8][9][10][11] The use of either allograft or autograft has been described, although no direct comparison studies exist. [8][9][10] Potential graft choices include semitendinosus, gracilis, palmaris longus, and subclavius.…”

“…3,[7][8][9][10][11] The use of either allograft or autograft has been described, although no direct comparison studies exist. [8][9][10] Potential graft choices include semitendinosus, gracilis, palmaris longus, and subclavius. It is important to consider the size of the bony defect in relation to the length of the graft and potential donor site morbidity.…”

Sternoclavicular Joint Instability and Reconstruction

“…Overall, there is considerable variability in outcomes of the various reconstruction techniques reported in the literature, possibly because of small case series size or variance in surgical indications or techniques. 8 The authors' preferred technique is a figure-of-eight reconstruction technique using either semitendinosus allograft 38 or gracilis autograft. 39 Within the literature, figure-of-eight techniques have been more frequently used within more recent case series of SC joint Photographs showing that a shuttling suture is passed through the clavicular intramedullary canal and is used to pass the two ends of a semitendinosus allograft through the anterior clavicle hole in a luggage loop fashion (top).…”

“…The authors' preferred technique is a figure-of-eight reconstruction technique using either semitendinosus allograft 38 or gracilis autograft. 39 Within the literature, figure-of-eight techniques have been more frequently used within more recent case series of SC joint resections.…”

“…5 In cases of persistent symptomatic SC joint instability, an SC joint reconstruction procedure should be included in the surgical treatment plan, whereas patients with posttraumatic arthritis of the SC joint without persistent instability should be considered for an SC joint resection alone without reconstruction. 3,37,38 Persistent symptomatic SC joint instability can be diagnosed based on physical examination for either dislocation or subluxation of the SC joint or by the radiograph or CT scan for persistent dislocation.…”