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Plath JE, Martetschläger F, Moroder P, Sandmann G. Instabilities and Osteoarthritis of the Sternoclavicular Joint. ZEITSCHRIFT FUR ORTHOPADIE UND UNFALLCHIRURGIE 2024; 162:360-367. [PMID: 37647924 DOI: 10.1055/a-2109-3190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
Abstract
Injury to the sternoclavicular joint (SCG) is very rare, accounting for 3% of shoulder injuries and < 1% of instabilities. Consequently, both the treatment of acute instabilities and their subsequent states (chronic instabilities/SCG arthrosis) are controversial. While treatment has so far been mostly conservative, in recent years there has been a trend towards surgical therapy.Considerable violence, such as that found in traffic accidents or contact sports, can tear the extremely stable ligaments between the medial clavicle and sternum. While anterior dislocation is easier to reduce in most cases, instability remains in up to 50% of cases. In most cases, posterior instability requires rapid reduction, particularly due to the anatomical proximity to important cardio-pulmonary structures. If this succeeds, the rate of persistent instabilities is low. For chronic instability, reconstruction/augmentation of the ligament apparatus with tendon grafts in the "Figure of 8 configuration" has proven to be the standard technique in recent years.
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Affiliation(s)
| | | | - Philipp Moroder
- Abteilung Schulterchirurgie und Ellenbogenchirurgie, Schulthess Klinik Zürich, Zürich, Schweiz
| | - Gunther Sandmann
- Sportklinik Ravensburg, Sportklinik Ravensburg, Ravensburg, Deutschland
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2
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Ayekoloye CI, Yin Q, Wood A, Frostick S. Open sternoclavicular osteophyte debridement in the surgical management of sternoclavicular osteoarthritis: clinical outcome of a new procedure. Shoulder Elbow 2022; 14:162-168. [PMID: 35265182 PMCID: PMC8899320 DOI: 10.1177/1758573220972093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Revised: 10/12/2020] [Accepted: 10/15/2020] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Symptomatic sternoclavicular osteoarthritis is uncommon but remains the most frequent non-traumatic condition affecting the sternoclavicular joint and tends to have a predilection for middle-aged women. It responds well to conservative management. Surgery is indicated when conservative management fails. We present the clinical outcome of open symptomatic sternoclavicular osteophyte debridement, a new operation for treating recalcitrant symptomatic sternoclavicular osteoarthritis. METHODS Five patients (five symptomatic sternoclavicular joints) with symptomatic sternoclavicular osteoarthritis underwent open sternoclavicular debridement following failure of conservative treatment. There were three females and two males. Mean age was 46.6 years (range 37.17-66). Four cases were primary osteoarthritis and one case was secondary to trauma. They were reviewed at mean follow-up at 35.4 months with minimum follow-up of 29 months. Assessment included Quick Disabilities of Arm Shoulder and Hand (DASH) and subjective patient satisfaction score. RESULTS There was no post-operative complication. Mean Quick DASH score 10.9 (range 0-29.5) at mean 35.4-month follow-up (range 29-43 months). Three patients reported excellent and two reported good outcome as per subjective satisfaction score. CONCLUSIONS Open sternoclavicular debridement has proved to be a simple, safe and highly effective new surgical treatment for patients with symptomatic sternoclavicular osteoarthritis unresponsive to non-operative management.
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Affiliation(s)
- Charles I Ayekoloye
- Department of Orthopaedics, Royal Liverpool and Broadgreen University Hospital NHS Trust, Liverpool, UK,Charles I Ayekoloye, Department of Orthopaedics, Royal Liverpool and Broadgreen Hospital, Liverpool L7 8XP, UK.
| | - Qi Yin
- Department of Orthopaedics, Royal Liverpool and Broadgreen University Hospital NHS Trust, Liverpool, UK
| | - Amanda Wood
- Department of Molecular and Clinical Cancer Medicine, Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | - Simon Frostick
- Department of Molecular and Clinical Cancer Medicine, Institute of Translational Medicine, University of Liverpool, Liverpool, UK
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3
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Complications after sternoclavicular surgery. J Shoulder Elbow Surg 2021; 30:e392-e398. [PMID: 33038497 DOI: 10.1016/j.jse.2020.09.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 09/06/2020] [Accepted: 09/21/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND Sternoclavicular joint (SCJ) pathologies such as instability are rare; therefore, SCJ surgery is performed infrequently. Complications of these surgeries can be devastating. This study evaluated complications, and particularly infections, after SCJ surgery. METHODS A retrospective cohort of 68 patients who underwent SCJ surgery with a minimum follow-up of 1 year was reviewed. Patients' characteristics, intraoperative, and postoperative complications were retrieved. In case of a reoperation, relevant data from the reoperation and microbiological findings were collected. RESULTS Twenty-two men and 46 women with a mean age of 37.5 years (range, 13-70 years) were analyzed. A complication occurred in 26 of 68 patients (38.2%). In 16 patients (23.5%), this was an infection. Cutibacterium acnes was the pathogen in 14 of these infections. Infection occurred more often in men than in women (P = .02). A total of 26 reoperations were performed in our cohort: 14 due to clinical signs of infection, 9 due to instability, 1 due to complaints of SCJ osteoarthritis, and 2 due to other causes. CONCLUSION Complications after SCJ surgery occur more often than previously described. C. acnes infections are often seen. When left untreated, these complications can lead to persistent complaints or recurrent instability due to failure of reconstruction. Therefore, it is of utmost importance to identify infections at an early stage, or better, to prevent them. The use of benzoyl peroxide gel preoperatively seems effective in reducing early C. acnes infections in this type of surgery.
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Parker KM, Somerson JS, Warme WJ. Unicortical sternal graft reconstruction for anterior sternoclavicular joint instability. BMJ Case Rep 2021; 14:e237164. [PMID: 33692041 PMCID: PMC7949389 DOI: 10.1136/bcr-2020-237164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/23/2021] [Indexed: 11/04/2022] Open
Abstract
Sternoclavicular joint (SCJ) injury represents 3%-5% of all shoulder girdle injuries, yet can produce significant pain and disability. While conservative management improves symptoms in most cases, surgical intervention may be indicated for patients with symptoms recalcitrant to nonoperative treatment. A wide range of surgical stabilisation techniques is documented in the literature; however, the scarcity of SCJ pathology has hindered development of a 'gold standard'.We present a minimalistic medial clavicle osteoplasty and SCJ reconstruction using semitendinosus autograft anchored with unicortical sternal tunnels in the 54 years old with chronic SCJ instability. This technique can be performed safely, resulting in joint stability and pain reduction, while avoiding risks and complications noted in the literature with other techniques.
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Affiliation(s)
- Kate M Parker
- Department of Orthopaedics and Sports Medicine, University of Washington, Seattle, Washington, USA
| | - Jeremy S Somerson
- Department of Orthopaedic Surgery and Rehabilitation, University of Texas Medical Branch, Galveston, Texas, USA
| | - Winston J Warme
- Department of Orthopaedics and Sports Medicine, University of Washington, Seattle, Washington, USA
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5
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Garcia JA, Arguello AM, Momaya AM, Ponce BA. Sternoclavicular Joint Instability: Symptoms, Diagnosis And Management. Orthop Res Rev 2020; 12:75-87. [PMID: 32801951 PMCID: PMC7395708 DOI: 10.2147/orr.s170964] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Accepted: 07/13/2020] [Indexed: 12/24/2022] Open
Abstract
Sternoclavicular joint (SCJ) instability is a rare condition and results from either a traumatic high energy impact, such as a motor vehicle crash or contact sports injury, or non-traumatically as a result of structural pathology. The infrequency of this injury has contributed to its diagnosis being missed as well as the paucity of literature on treatment and outcomes. Patients with SCJ instability often report diminished range of motion as well as shoulder girdle pain. The presentation of instability in the sternoclavicular joint can vary in severity and anterior or posterior directionality. Variation in severity of the instability changes the course of treatment regarding either operative or non-operative interventions to stabilize the SCJ. In general, anterior instability of the SCJ (the medial clavicle is displaced anterior to the sternum) is less urgent and generally manageable by symptom alleviation and rehabilitation, although some anterior instability cases require surgical intervention. In the case of posterior SCJ instability (the medial clavicle is displaced posterior to the sternum), patients require prompt joint reduction as they are at the greater risk of life-threatening injury due to the location of critical structures of the mediastinum posterior to the SCJ. Computed tomography visualization is useful to confirm dislocation or subluxation direction to better formulate a proper treatment plan. The purpose of this review is to report the clinical presentation and management of SCJ instability including pertinent symptoms, the diagnostic approaches to evaluating SCJ instability, as well as operative and non-operative management of the joint instability.
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Affiliation(s)
- Jacob A Garcia
- University Of Alabama At Birmingham School Of Medicine, Birmingham, AL 35294, USA
| | - Alexandra M Arguello
- University Of Alabama At Birmingham, Department Of Orthopedic Surgery, Birmingham, AL 35294, USA
| | - Amit M Momaya
- University Of Alabama At Birmingham, Department Of Orthopedic Surgery, Birmingham, AL 35294, USA
| | - Brent A Ponce
- University Of Alabama At Birmingham, Department Of Orthopedic Surgery, Birmingham, AL 35294, USA
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6
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Editorial Commentary: Sternoclavicular Joint Osteoarthritis Surgical Treatment Offers Benefits as Well as Risks. Arthroscopy 2020; 36:1230-1232. [PMID: 32370885 DOI: 10.1016/j.arthro.2020.02.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Accepted: 02/18/2020] [Indexed: 02/02/2023]
Abstract
Sternoclavicular (SC) joint surgical procedures have risks as well as benefits and should be performed by experienced surgeons with a good understanding of the neurovascular anatomy and with a thoracic surgeon on call. Computed tomography angiograms to evaluate the proximity of the SC joint to the blood vessels are essential for preoperative planning. Care must be taken to exclude instability as a cause of SC joint symptoms, and surgeons must avoid causing iatrogenic instability. Both arthroscopic and open approaches can result in excellent clinical outcomes for patients with symptomatic SC arthritis. We prefer an open approach because an arthroscopic approach may have a greater risk of complications. In our experience, after surgical treatment of SC arthritis, 67% of patients return to sport at 2-year minimum follow-up.
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Tytherleigh-Strong G, Gill J, Mulligan A, Al-Hadithy N. Arthroscopic Excision Arthroplasty of the Sternoclavicular Joint for Osteoarthritis: A Case Series of 50 Patients. Arthroscopy 2020; 36:1223-1229. [PMID: 31862291 DOI: 10.1016/j.arthro.2019.12.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2019] [Revised: 12/06/2019] [Accepted: 12/08/2019] [Indexed: 02/02/2023]
Abstract
PURPOSE to report the results of a consecutive series of 50 patients who underwent an arthroscopic excision of the sternoclavicular joint (SCJ) for primary osteoarthritis refractory to conservative treatment. METHODS We undertook an arthroscopic excision of the SCJ in 50 patients with primary osteoarthritis refractory to conservative treatment. This included an adequate course of physiotherapy and at least 1 ultrasound-guided cortisone injection. There were 26 female and 24 male patients and the mean age at the time of surgery was 54.5 years (range 39-72 years). Patients were assessed preoperatively and at final follow-up with the Constant, Rockwood SCJ, and Quick-DASH scores. The mean follow-up was 41.8 months (range 24-73 months). Surgery was undertaken as a day-case with no shoulder immobilization. RESULTS Forty-five patients were available at final-follow up. The median Constant score had increased from 55 (range 37-79) to 72 (range 38-92), Rockwood score from 6 (range 4-9) to 13 (range 4-15), and Quick-DASH 36 (range 18-69) to 12 (range 0-51). All of these changes were statistically significant (P < .0001). There were no complications and, specifically, no problems with joint instability. Forty-four of the 45 patients were pleased with the results of their surgery and indicated that they would be happy to have the procedure again. CONCLUSIONS The results of this study show that arthroscopic excision arthroplasty of the SCJ is a satisfactory treatment for primary SCJ osteoarthritis refractory to conservative treatment. LEVEL OF EVIDENCE Level IV case series.
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Affiliation(s)
- Graham Tytherleigh-Strong
- Division of Orthopaedics, Addenbrookes Hospital, Cambridge University Hospitals NHS Trust, Cambridge, United Kingdom.
| | - James Gill
- Division of Orthopaedics, Addenbrookes Hospital, Cambridge University Hospitals NHS Trust, Cambridge, United Kingdom
| | - Alex Mulligan
- Division of Orthopaedics, Addenbrookes Hospital, Cambridge University Hospitals NHS Trust, Cambridge, United Kingdom
| | - Nawfal Al-Hadithy
- Division of Orthopaedics, Addenbrookes Hospital, Cambridge University Hospitals NHS Trust, Cambridge, United Kingdom
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Dekker TJ, Lacheta L, Goldenberg BT, Horan MP, Pogorzelski J, Millett PJ. Minimum 5-Year Outcomes and Return to Sports After Resection Arthroplasty for the Treatment of Sternoclavicular Osteoarthritis. Am J Sports Med 2020; 48:715-722. [PMID: 31940214 DOI: 10.1177/0363546519897892] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Osteoarthritis of the sternoclavicular (SC) joint is a rare condition that leads to decreased function and persistent pain, ultimately altering the function of the shoulder and keeping individuals from their desired activities. SC resection in the setting of primary and posttraumatic osteoarthritis is the most common surgical treatment for these patients, but midterm results are lacking. PURPOSE/HYPOTHESIS The purpose was to assess the clinical outcomes, pain levels, return to sports rate, and survivorship after open SC joint resection in the setting of painful primary SC joint osteoarthritis. We hypothesized that an SC joint resection of maximum 10 mm would result in a significant improvement in clinical outcomes, decreased pain levels, a high rate of return to sports, and a high survivorship. STUDY DESIGN Case series; Level of evidence, 4. METHODS Patients who underwent SC joint resection (maximum 10 mm) by a single surgeon between the years 2006 and 2013 with minimum 5-year follow-up were reviewed. The following clinical outcomes were collected prospectively during this time period: 12-Item Short Form Health Survey Physical Component Score (SF-12 PCS), American Shoulder and Elbow Surgeons (ASES) score, Single Assessment Numerical Evaluation (SANE) score, Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) score, and patient satisfaction. Return to sports and pain were assessed through use of a customized questionnaire. Survivorship of SC joint resection was defined as not requiring further surgery on the affected joint. RESULTS A total of 21 SC joints were treated with resection of the medial clavicle and intra-articular disk and capsulorrhaphy for SC joint osteoarthritis in 19 patients with a mean age of 39.4 years (range, 12.5-66.7 years). At minimum 5-year follow-up, 19 SC joint resections were assessed in 16 of 19 patients (84%) with a mean follow-up of 6.7 years (range, 5.0-10.4 years). All outcome scores improved significantly from pre- to postoperative assessments: ASES (from 54 to 90.5; P = .003), SANE (from 61.8 to 90.4; P = .004), QuickDASH (from 43.1 to 13.8; P = .004), and SF-12 PCS (from 39.8 to 51.3; P = .004). Median satisfaction with surgical outcomes was 9 (range, 2-10), and pain levels improved from a score of 8 out of 10 to 3 out of 10 (scale of 0 to 10 with 0 being pain free and 10 worst possible pain). Of the 13 patients who answered the optional sports participation question, 13 (100%) patients had participated in sports before their injury. A total of 14 patients answered the question on sports participation after injury, with 12 (86%) indicating successful return to sports. Pain at its worst (P = .003) and pain with competition (P = .017) significantly decreased pre- to postoperatively. Resection survivorship at final follow-up was 84.2% at 5 years. We found that 3 patients (15%) had recurrent SC joint pain and were treated with revision surgery. CONCLUSION Open SC resection arthroplasty with capsulorrhaphy in the setting of pain for SC osteoarthritis results in significant improvement in clinical outcomes, patient satisfaction, return to sports, and pain reduction at minimum 5-year follow-up.
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Affiliation(s)
- Travis J Dekker
- The Steadman Clinic, Vail, Colorado, USA.,Steadman Philippon Research Institute, Center for Outcomes-Based Orthopaedic Research, Vail, Colorado, USA
| | - Lucca Lacheta
- Steadman Philippon Research Institute, Center for Outcomes-Based Orthopaedic Research, Vail, Colorado, USA.,Center for Musculoskeletal Surgery, Charité-Universitaetsmedizin Berlin, Berlin, Germany
| | - Brandon T Goldenberg
- Steadman Philippon Research Institute, Center for Outcomes-Based Orthopaedic Research, Vail, Colorado, USA
| | - Marilee P Horan
- Steadman Philippon Research Institute, Center for Outcomes-Based Orthopaedic Research, Vail, Colorado, USA
| | - Jonas Pogorzelski
- Steadman Philippon Research Institute, Center for Outcomes-Based Orthopaedic Research, Vail, Colorado, USA
| | - Peter J Millett
- The Steadman Clinic, Vail, Colorado, USA.,Steadman Philippon Research Institute, Center for Outcomes-Based Orthopaedic Research, Vail, Colorado, USA
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Sanchez-Sotelo J, Baghdadi Y, Nguyen NTV. Sternoclavicular joint allograft reconstruction using the sternal docking technique. JSES OPEN ACCESS 2018; 2:190-193. [PMID: 30675593 PMCID: PMC6334850 DOI: 10.1016/j.jses.2018.08.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background The sternoclavicular joint may become unstable as a result of trauma or medial clavicle resection for arthritis. Allograft reconstruction with the figure-of-8 configuration is commonly used. This study was conducted to determine the outcome of sternoclavicular joint reconstruction using an alternative graft configuration. Methods Between 2005 and 2013, 19 sternoclavicular joint reconstructions were performed using a semitendinous allograft in a sternal docking configuration. The median age at surgery was 44 years (range, 15-79 years). Indications included instability in 16 (anterior, 13; posterior, 3) or medial clavicle resection for osteoarthritis in 3. The median follow-up time was 3 years (range, 1-9 years). Results Two reconstructions (10.5%) underwent revision surgery, 1 additional patient had occasional subjective instability, and the remaining 16 (84%) were considered stable. Sternoclavicular joint reconstruction led to improved pain (visual analog scale for pain subsided from 5 to 1 point, P < .01), with pain being rated as mild or none for 15 shoulders. At the most recent follow-up, the median 11-item version of the Disabilities of the Arm, Shoulder and Hand and American Shoulder and Elbow Surgeons scores were 11 (interquartile range [IQR], 0-41) and 88 (IQR, 62-100) respectively. The cosmetic aspect of the shoulder was satisfactory in 16 reconstructions (84%), with a median of 10 points (IQR, 9-10 points) on the visual analog scale for overall satisfaction. Conclusion Reconstruction of the sternoclavicular joint with a semitendinous allograft in a sternal docking fashion restores stability in most patients requiring surgery for instability of the sternoclavicular joint or medial clavicle resection for osteoarthritis.
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Affiliation(s)
| | - Yaser Baghdadi
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
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Edwin J, Ahmed S, Verma S, Tytherleigh-Strong G, Karuppaiah K, Sinha J. Swellings of the sternoclavicular joint: review of traumatic and non-traumatic pathologies. EFORT Open Rev 2018; 3:471-484. [PMID: 30237905 PMCID: PMC6134883 DOI: 10.1302/2058-5241.3.170078] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
The sternoclavicular joint (SCJ) is an integral part of the shoulder girdle that connects the upper limb to the axial skeleton. Swelling of the SCJ is commonly due to trauma, degeneration, infections and other disease processes that affect synovial joints. This review also focuses on uncommon conditions that could affect the SCJ, including SAPHO (synovitis, acne, pustulosis, hyperostosis, osteitis) syndrome, Friedrich’s disease and Tietze syndrome. The scope of this review is limited to the analysis of the current evidence on the various conditions affecting the SCJ and also to provide an algorithm to manage these conditions.
Cite this article: EFORT Open Rev 2018;3:471-484. DOI: 10.1302/2058-5241.3.170078
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Affiliation(s)
| | - Shahbaz Ahmed
- Pulvertaft Hand Centre, Royal Derby Hospital, Derby, UK
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Tytherleigh-Strong G, Rashid A, Lawrence C, Morrissey D. Arthroscopic Sternoclavicular Joint Diskectomy for Acute and Chronic Tears. Arthroscopy 2017; 33:1965-1970. [PMID: 28847575 DOI: 10.1016/j.arthro.2017.06.033] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Revised: 05/07/2017] [Accepted: 06/17/2017] [Indexed: 02/02/2023]
Abstract
PURPOSE To describe the results and functional scores in a group of patients who underwent arthroscopic excision of a symptomatic sternoclavicular joint (SCJ) disk tear with a minimum follow-up period of 2 years. METHODS Between April 2010 and December 2014, 14 patients underwent arthroscopic excision of a torn SCJ disk. Patients whose intended surgery was an isolated diskectomy and underwent that surgery only, with no additional procedure, were included. The minimum follow-up period was 24 months. All patients underwent an arthroscopic SCJ diskectomy. Postoperatively, no immobilization was required, and the patients were encouraged to mobilize as pain permitted. The patients were assessed preoperatively and at final follow-up with the visual analog scale score for pain, Rockwood score, and QuickDASH (short version of the Disabilities of the Arm, Shoulder and Hand questionnaire) score. RESULTS The average age at surgery was 29.4 years (range, 19-39 years). Ten of the patients had been symptom free before a specific incident, after which SCJ symptoms developed. The other 4 patients reported a gradual onset of symptoms and were considered to have chronic tears. The average duration of symptoms was 22.8 months (range, 6-48 months). At a mean follow-up of 33.4 months (range, 24-59 months), a significant improvement in the Rockwood score was noted, from 7 (range, 5-9; standard deviation [SD], 1.4) to 13.6 (range, 9-15; SD, 1.9) (P = .001) (minimal clinically important difference not described). The mean QuickDASH score improved from 23.7 points (range, 6.8-40.9 points; SD, 11.8 points) to 8 points (range, 0-29.5 points; SD, 9 points) (P = .0024) (minimal clinically important difference, 13.4 points). There were no reported complications and specifically no instability. CONCLUSIONS The results of this series suggest that arthroscopic SCJ diskectomy is a safe and reproducible procedure for the treatment of patients with symptomatic SCJ disk tears. LEVEL OF EVIDENCE Level IV, therapeutic case series.
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Affiliation(s)
- Graham Tytherleigh-Strong
- Division of Orthopaedics, Addenbrooke's Hospital, Cambridge University Hospitals NHS Trust, Cambridge, England.
| | - Abbas Rashid
- Division of Orthopaedics, Addenbrooke's Hospital, Cambridge University Hospitals NHS Trust, Cambridge, England
| | - Christopher Lawrence
- Division of Orthopaedics, Addenbrooke's Hospital, Cambridge University Hospitals NHS Trust, Cambridge, England
| | - David Morrissey
- Division of Orthopaedics, Addenbrooke's Hospital, Cambridge University Hospitals NHS Trust, Cambridge, England
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Tytherleigh-Strong G, Van Rensburg L. Arthroscopic Excision of the Sternoclavicular Joint. Arthrosc Tech 2017; 6:e1697-e1702. [PMID: 29399453 PMCID: PMC5795018 DOI: 10.1016/j.eats.2017.06.026] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Accepted: 06/22/2017] [Indexed: 02/03/2023] Open
Abstract
Osteoarthritis changes at the sternoclavicular joint (SCJ) have been shown to be present on computed tomography in more than 90% of people over the age of 60 years. Although usually asymptomatic, when symptoms do occur, they can be very debilitating. Most patients respond favorably to conservative treatment, but there is a small cohort of patients who continue to be symptomatic despite adequate conservative treatment. Surgical management with an open SCJ excision has been shown to give satisfactory results. However, probably due to concerns with regard to damage to the mediastinal structures, instability, and scarring, there is a high threshold for surgery. Arthroscopic SCJ excision has been shown to achieve similar results to an open procedure while avoiding some of the risks. In this Technical Note, we describe the indications, imaging, and the technique of an arthroscopic excision of the SCJ.
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Affiliation(s)
- Graham Tytherleigh-Strong
- Address correspondence to Graham Tytherleigh-Strong, F.R.C.S.(Orth), F.F.S.E.M.(UK), Division of Orthopaedics, Addenbrooke's Hospital, Cambridge University Hospitals Trust, Cambridge CB2 2QQ, U.K.Division of OrthopaedicsAddenbrooke's HospitalCambridge University Hospitals TrustCambridgeCB2 2QQU.K.
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Tytherleigh-Strong G, Rashid A, Lawrence C, Morrissey D. Arthroscopic Intra-articular Disk Excision of the Sternoclavicular Joint. Arthrosc Tech 2017; 6:e599-e605. [PMID: 28706805 PMCID: PMC5495580 DOI: 10.1016/j.eats.2017.01.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Accepted: 01/05/2017] [Indexed: 02/03/2023] Open
Abstract
The sternoclavicular joint (SCJ) has a complete intra-articular disk that can be damaged either as a result of trauma or as part of ongoing degenerative joint disease. Although often asymptomatic, SCJ disk tears may lead to mechanical symptoms and pain. Previously, isolated symptomatic SCJ disk tears have only occasionally been mentioned in the literature with a few associated case reports of diskectomy by open arthrotomy. With improved imaging and availability of magnetic resonance imaging scans and the advent of SCJ arthroscopy it is now possible to treat symptomatic SCJ disk tears by arthroscopic excision. In this Technical Note, we describe the diagnosis of a torn SCJ disk and the technique of arthroscopic excision of a torn SCJ disk.
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Minimum 2-year outcomes and return to sport following resection arthroplasty for the treatment of sternoclavicular osteoarthritis. J Shoulder Elbow Surg 2017; 26:e37-e43. [PMID: 27727060 DOI: 10.1016/j.jse.2016.07.008] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Revised: 06/27/2016] [Accepted: 07/01/2016] [Indexed: 02/01/2023]
Abstract
HYPOTHESIS The aim of this study was to assess the effect of open resection arthroplasty for osteoarthritis of the sternoclavicular (SC) joint on pain levels, functional outcomes, and return to sport. METHODS Patients from a single surgeon's practice who underwent open resection arthroplasty (maximum 10-mm resection) for SC osteoarthritis or prearthritic changes between November 2006 and November 2013 were retrospectively reviewed. This was an outcomes study with prospectively collected data. Preoperative and postoperative American Shoulder and Elbow Surgeons score, Quick Disabilities of the Arm, Shoulder, and Hand score, Single Assessment Numeric Evaluation score, several pain scores, and level of sport intensity were assessed. RESULTS Seventeen SC joints in 16 patients (9 female, 7 male) met inclusion criteria. Mean age at time of surgery way 41.1 years (range, 12-66 years). One patient refused participation in the study. Three SC joint resections (17.7%) required SC joint revision surgery. Minimum 2-year outcomes data were available for 11 of the remaining 13 SC joints (84.6%). The mean time to follow-up was 3.3 years (range, 2.0-8.8 years). Pain at its worst (P = .026), pain at competition (P = .041), the Quick Disabilities of the Arm, Shoulder, and Hand score (P = .034), and the ability to sleep on the affected shoulder (P = .038) showed significant improvement postoperatively. The average postoperative American Shoulder and Elbow Surgeons score was 83.3. The level of sports participation (P = .042) as well as strength and endurance when participating in sport (P = .039) significantly increased postoperatively. CONCLUSION Resection arthroplasty of the medial end of the clavicle in patients with osteoarthritis of the SC joint without instability results in pain reduction, functional improvement, and a high rate of return to sport at midterm follow-up.
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Katthagen JC, Marchetti DC, Dahl KD, Turnbull TL, Millett PJ. Biomechanical Comparison of Surgical Techniques for Resection Arthroplasty of the Sternoclavicular Joint. Am J Sports Med 2016; 44:1832-6. [PMID: 27159312 DOI: 10.1177/0363546516639302] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The optimal location and extent of medial clavicle resection for sternoclavicular (SC) joint resection arthroplasty are unknown. HYPOTHESIS Resection of the intra-articular disc alone cannot reliably decompress the SC joint, and a parallel resection technique will decompress the SC joint significantly more compared with the same amount with an oblique resection technique. STUDY DESIGN Controlled laboratory study. METHODS Force transmission through the SC joint was measured in 7 matched-pair human cadaveric SC joints in a dynamic tensile testing machine. The specimens were randomized to either a parallel or an oblique resection technique. An 80-N axial load was applied on the lateral clavicle toward the SC joint in each of the following 4 conditions: (1) intact joint, (2) after resecting the intra-articular disc, (3) after resecting 5 mm of the medial clavicle, and (4) after 10-mm resection. RESULTS Complete discectomy of all SC joints resulted in a significant reduction of force transmitted through the SC joint (P = .002). However, the varying anatomy of the disc was accompanied by a varying amount of joint decompression (95% CI, 29.8%-65.4%). Resecting 5 mm of the SC joint with the parallel technique decompressed the SC joint by a mean (±SD) of 76.7 ± 22.1 N compared with 37.8 ± 24.8 N with the oblique technique (P = .02). Decompression did not significantly differ between the groups after 10-mm resection (P = .18) using the parallel technique (89.4 ± 24.1 N) compared with the oblique technique (68.2 ± 31.6 N). Furthermore, 5-mm resection of the medial end of the clavicle with the parallel technique decompressed the SC joint by an amount similar to 10-mm resection with the oblique technique. CONCLUSION Resection of the disc alone did not reliably decompress each SC joint. Resection of 5 mm of the medial end of the clavicle with the parallel resection technique reliably decompressed the SC joint better than with the oblique resection technique. CLINICAL RELEVANCE This study provides baseline data on SC joint resection techniques and their mechanical effects. This knowledge can be implemented in clinical practice to treat patients with symptomatic posttraumatic arthritis of the SC joint.
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Affiliation(s)
| | | | - Kimi D Dahl
- Steadman Philippon Research Institute, Vail, Colorado, USA
| | | | - Peter J Millett
- Steadman Philippon Research Institute, Vail, Colorado, USA The Steadman Clinic, Vail, Colorado, USA
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Lee JT, Campbell KJ, Michalski MP, Wilson KJ, Spiegl UJA, Wijdicks CA, Millett PJ. Surgical anatomy of the sternoclavicular joint: a qualitative and quantitative anatomical study. J Bone Joint Surg Am 2014; 96:e166. [PMID: 25274794 DOI: 10.2106/jbjs.m.01451] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND The quantitative anatomical relationships of the main ligamentous, tendinous, and osseous structures of the sternoclavicular joint have not been widely investigated. The purpose of this study was to provide a quantitative description of the sternoclavicular joint in relation to relevant surgical landmarks. METHODS We dissected eleven nonpaired, fresh-frozen cadaveric sternoclavicular joints from four men and seven women (mean age at death, fifty-three years; range, thirty-three to sixty-four years) and measured the ligaments, musculature, and osseous landmarks with use of a three-dimensional coordinate-measuring device. RESULTS The clavicular pectoralis ridge, located at the 9:30 clock-face position on a right clavicle, served as a reliable osseous landmark for reference to the soft-tissue attachments around the sternoclavicular joint. The costoclavicular ligament was the largest ligament of the sternoclavicular joint, with 80% greater footprint area than that of the posterior sternoclavicular ligament. Articular cartilage covered 67% of the medial end of the clavicle and was located anteroinferiorly. The sternohyoid muscle inserted directly over the posterior sternoclavicular joint and the medial end of the clavicle, whereas the sternothyroid muscle inserted 9.5 mm inferior to the posterior-superior articular margin of the manubrium and coursed 19.8 mm laterally along the first rib. An avascular plane that can serve as a "safe zone" for posterior dissection was observed in each specimen, posterior to the sternoclavicular joint and anterior to the sternohyoid and sternothyroid muscles. CONCLUSIONS The clavicular pectoralis ridge can be used as an intraoperative guide for clavicle orientation and tunnel placement in sternoclavicular ligament reconstruction. Sternoclavicular joint resection arthroplasty should avoid injuring the costoclavicular ligament, which is the largest sternoclavicular joint ligament. Resection of only the anteroinferior aspect of the medial end of the clavicle may provide adequate decompression while preserving the stability of the clavicle. The location of the sternohyoid and sternothyroid musculotendinous insertions appear to provide a "safe zone" for posterior clavicle and manubrial dissection.
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Affiliation(s)
- Jared T Lee
- Steadman Philippon Research Institute, 181 West Meadow Drive, Suite #1000, Vail, CO 81657. E-mail address for P.J. Millett:
| | - Kevin J Campbell
- Steadman Philippon Research Institute, 181 West Meadow Drive, Suite #1000, Vail, CO 81657. E-mail address for P.J. Millett:
| | - Max P Michalski
- Steadman Philippon Research Institute, 181 West Meadow Drive, Suite #1000, Vail, CO 81657. E-mail address for P.J. Millett:
| | - Katharine J Wilson
- Steadman Philippon Research Institute, 181 West Meadow Drive, Suite #1000, Vail, CO 81657. E-mail address for P.J. Millett:
| | - Ulrich J A Spiegl
- Steadman Philippon Research Institute, 181 West Meadow Drive, Suite #1000, Vail, CO 81657. E-mail address for P.J. Millett:
| | - Coen A Wijdicks
- Steadman Philippon Research Institute, 181 West Meadow Drive, Suite #1000, Vail, CO 81657. E-mail address for P.J. Millett:
| | - Peter J Millett
- Steadman Philippon Research Institute, 181 West Meadow Drive, Suite #1000, Vail, CO 81657. E-mail address for P.J. Millett:
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