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An Option for Sternoclavicular Joint Reconstruction

Pain and dysfunction of the sternoclavicular (SC) joint, which is where the collar bone attaches to the sternum, is rare but can be quite problematic. This joint is important for normal arm movements and when it becomes unstable it is usually in the anterior direction. Excess movement here is usually the result of a traumatic event but can also be due to degenerative changes, or general laxity. There are several surgical techniques in use if conservative treatment is not effective, and this study looks at the results of one of these techniques. The specific technique researched in this study uses the tendon of the sternocleidomastoid (SCM) muscle to anchor the collar bone to the sternum.

This technique takes a part of the tendon from a large neck muscle, the SCM, loops it through a tunnel created in the end of the collar bone and then anchors it down to the sternum. The purpose is to provide stability to prevent excess movement, pain and dysfunction of the arm.

In this retrospective study there were thirty-two patients who underwent this surgery from 2005-2010. Fourteen patients had pain in the SC joint following a traumatic event, mean age twenty four; seven presented with generalized laxity, mean age of twenty three; and eleven had evidence of osteoarthritis mean age of fifty one. The duration of symptoms prior to surgery for all the patients was over two years, for the patients with degenerative changes it was just over four years and for the patients with hyper laxity they had symptoms for over six years before surgery. All patients were followed for forty-four months following their procedure.

The clinical scores and the pain rating for all three groups improved significantly and to the same extent for each group. There was persistent instability in two patients, both of which declined further intervention. There were no other complications reported.

Numerous surgical techniques for treatment of this problem have been described in the literature, but this is the largest study performed on one single technique to date. Fortunately it appears that this is a highly successful technique, with good clinical and functional outcomes and minimal to no complications. This technique also appears to be equally effective for the multiple causes of SC joint pain. The results of this study suggest that SC joint reconstruction with the SCM tendon graft is a safe and reliable technique for patients with debilitating instability at the SC joint.

References: Ofir Uri, MD, et al. Clinical Outcome After Reconstruction for Sternoclavicular Joint Instability Using a Sternocleidomastoid Tendon Graft. In The Journal of Bone and Joint Surgery. March 2014. Vol. 96-A. No. 5. Pp. 417-422.

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