Chronic Recurrent Anterior Sternoclavicular Joint Instability

Abstract

Chronic anterior sternoclavicular joint (SCJ) instability may cause pain and persistent functional limitation in active patients. Although SCJ reconstruction and medial clavicular resection have been advocated in these situations, the results of surgical treatment are not well characterized. The purpose of this investigation was to determine the functional outcome of surgical treatment in adolescent and young adult patients with chronic recurrent anterior SCJ instability. Fifteen patients with chronic recurrent anterior SCJ instability refractory to nonoperative therapy who underwent joint reconstruction or medial clavicular resection were evaluated for pain and function using the American Shoulder and Elbow Surgeons (ASES) Standard Shoulder Assessment Form and the Simple Shoulder Test (SST). At average follow-up of 55 months, the mean ASES score was 85 and the mean SST score was 10.9. Sixty percent of patients reported stable, pain-free joints, although 87% (n = 13) reported some limitations of athletic or recreational activity. There were no surgical complications, and no patient underwent subsequent revision procedures. Although subsequent activity modification is often required, surgical treatment of chronic anterior SCJ instability in adolescents and young adults can provide near-complete pain relief and return of shoulder and upper extremity function.

Surgical Technique: Results of Stabilization of Sternoclavicular Joint Luxations Using a Polydioxanone Envelope Plasty

“…One patient had postoperative shoulder impairment (14%). Bae et al [4] treated nine chronic anterior luxations in children using tendon grafts, resulting in an average postoperative SST score of 11.4. These results are difficult to compare with our results because Bae et al [4] operated on children and Armstrong and Dias [3] did not use comparable outcome measures.…”

“…Bae et al [4] treated nine chronic anterior luxations in children using tendon grafts, resulting in an average postoperative SST score of 11.4. These results are difficult to compare with our results because Bae et al [4] operated on children and Armstrong and Dias [3] did not use comparable outcome measures. Glass et al [12] and Abbidin et al [1] reported Constant-Murley scores and had lower functional scores than we found in our study.…”

“…There are numerous treatment options described in the literature [1-4, 7, 9, 10, 12, 13, 17, 18, 23], but studies reporting the results of different techniques are few and mostly outdated [1,3,4,9,12,17]. Therefore, there is no favorable surgical treatment for sternoclavicular luxations when nonoperative treatment has failed.…”

CORR Insights®: Surgical Technique: Results of Stabilization of Sternoclavicular Joint Luxations Using a Polydioxanone Envelope Plasty

“…The authors correctly emphasize the risks with this technique, but mediastinal complications have not been reported in experienced hands. Bae et al [1] reported nine successful cases, with simple shoulder test scores averaging 11.2 and no complications, failures, or reoperations. These results mirror my clinical experience with 15 similar cases using this approach.…”

Thoracic wall trauma—misdiagnosed lesions on radiographs and usefulness of ultrasound, multidetector computed tomography and magnetic resonance imaging

“…However, some patients may develop chronic anterior instability and may continue to present symptoms. In these cases, surgical treatment is indicated (27). Sternoclavicular dislocations usually occur following traumatic events.…”