Treatment of First-Time Traumatic Anterior Dislocation of the Sternoclavicular Joint With Surgical Repair of the Anterior Capsule Augmented With Internal Bracing

Abstract

Background:Traumatic anterior dislocations of the sternoclavicular joint (SCJ) are rare. Although they can usually be treated by a closed reduction, the reported subsequent recurrence rate is 50%.Purpose:To determine whether further instability after first-time traumatic anterior dislocation would be prevented by a minimally invasive open repair of the anterior SCJ capsule, augmented with internal bracing.Study Design:Case series; Level of evidence, 4.Methods:Open repair of the anterior SCJ capsule was completed on a series of patients who had sustained a first-time traumatic anterior dislocation of the SCJ. Patients with preexisting SCJ instability and recurrent dislocations were excluded. Through a transverse incision, the anterior SCJ capsule was repaired and plicated by use of sutures. The repair was then protected by use of an internal brace, bridging between the sternum and the medial end of the clavicle.Results:Six patients (4 males, 2 females) with a mean age of 28.3 years were included. Four patients underwent surgery within 4 weeks of their dislocation, and 2 patients had ongoing symptoms of instability but had not had a further dislocation. The median follow-up was 28.2 months (range, 24-35 months). At the most recent follow-up, none of the patients had sustained further dislocation or episode of instability, and their SCJs appeared stable. The mean abbreviated Disabilities of the Arm, Shoulder and Hand (QuickDASH) score was 2.3 (range, 0-4.5).Conclusion:The medium-term results of this case series suggest that after first-time dislocation, surgical repair of the anterior SCJ capsule augmented with internal bracing can prevent recurrent instability. This may be an attractive option for individuals involved in higher risk activities, as the operative management of recurrent anterior SCJ instability usually requires a figure-of-8 tendon reconstruction, which carries a significantly higher morbidity.

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

“…Overall functional outcomes following nonoperative or operative treatment were better for patients with acute dislocations than they were for patients with chronic dislocations. Other small case series and case report studies have reported full return to activities following surgery for acute and chronic SC joint instability 1, 5, 7, 16, 17, 18, 19…”

“…Ligamentous reconstruction has gained favor in recent years given the reduced risk of neurovascular injury compared with screw or K-wire fixation. Variable treatment algorithms and surgical techniques have been described in the literature for the management of this condition, which has led to a lack of consistency in treatment14, 15, 16, 17; most notably, surgeons often differ in their choice of the type of tendon graft to use, whether to use autograft or allograft, and the specific reconstruction technique. A recent biomechanical study of a figure-of-8 reconstruction technique with semitendinosus graft found excellent strength with this reconstruction technique, 4 and it thus served as the basis of the current proposed technique.…”

<p>Sternoclavicular Joint Instability: Symptoms, Diagnosis And Management</p>

“…37 Recently, outcomes of a case series of first-time anterior SCJ dislocators who underwent capsular plication bolstered by internal bracing with suture tape were published. 44 At a minimum of 2 year follow up, there were no recurrences of dislocation or any evidence of instability or subluxation. There were no reported complications with the procedure, and all patients returned to sport within 1 year of the procedure.…”

Dislocations of the acromioclavicular and sternoclavicular joint in children and adolescents: A retrospective clinical study and big data analysis of routine data

“…The problem with anterior SCJ dislocation is less in possible concomitant injuries than in the development of chronic instability [9,32]. This can arise after primary conservative therapy as well as after primary surgical care.…”

“…This can arise after primary conservative therapy as well as after primary surgical care. To avoid this, more elaborate procedures are described in the literature, such as the combination of cerclages and reconstruction of capsule/ muscles and tendon plastic, which are also used for the secondary treatment of remaining instabilities [10,32,33]. Above all, Thut et al describe the experience in which the use of tendon grafts promises more lasting stability than the reconstruction with local tissue alone [33].…”