Sternoclavicular instability - reconstruction of sternoclavicular ligament using semitendinosus autograft
Keywords:Sternoclavicular joint, Instability, Reconstruction, Semitendinosus
Background: Injury to the sternoclavicular joint is rare with an incidence of 3% of all the injuries around the shoulder girdle. Most of them heal with conservative treatment. Rarely some progress to chronic instability associated with pain.
Methods: We present a small series of 4 such cases of chronic symptomatic sternoclavicular joint instability. We performed reconstruction of the sternoclavicular ligament using semitendinosus autograft, with excellent result, with minimum of 15 months follow up.
Results: All the patients returned to pre injury level of activity at the end of 6 months. There was significant improvement in the DASH score following surgery. Our results are comparable with that of Castropil et al, who had performed a similar technique.
Conclusions: Reconstruction of sternoclavicular ligament using the semitendinosus autograft is a safe, reproducible and functionally good surgical option in patients with chronic sternoclavicular instability.
DePalma AF. Surgical anatomy of acromioclavicular and sternoclavicular joints. Surg Clin North Am. 1963;43:1541-50.
Brown JE. Anterior sternoclavicular dislocation: A method of repair. Am J Orthop. 1961;31:184-9.
Wirth MA, Rockwood CA. Disorders of the sternoclavicular joint. In: The Shoulder. 4th ed. Rockwood CA Jr, Matsen FA III, Wirth MA, Lippitt SB, editors. Philadelphia, PA: Saunders; 2009: 527-560.
Hobbs DW. Sternoclavicular joint: A new axial radiographic view. Radiology. 1968;90:801.
Heinig CF. Retrosternal dislocation of the clavicle: Early recognition, x-ray diagnosis, and management [abstract]. J Bone Joint Surg Am. 1968;50:830.
Dhillon MS, Gupta RK, Bahadur R, Nagi ON. Tuberculosis of the sternoclavicular joints. Acta Orthop Scand. 2001;72:514-7.
Groh GI, Wirth MA. Management of traumatic sterno-clavicular joint injuries. J Am Acad Orthop Surg. 2011;19:1-7.
Pate JW, Wilhite JL. Migration of a foreign body from the sternoclavicular joint to the heart: A case report. Am Surg. 1969;35(6):448-9.
Leonard JW, Gifford RW Jr. Migration of a Kirschner wire from the clavicle into the pulmonary artery. Am J Cardiol. 1965;16(4):598-600.
Smolle-Juettner FM, Hofer PH, Pinter H, Friehs G, Szyskowitz R. Intracardiac malpositioning of a sternoclavicular fixation wire. J Orthop Trauma. 1992;6(1):102-5.
Armstrong AL, Dias JJ. Reconstruction for instability of the sternoclavicular joint using the tendon of the sternocleidomastoid muscle. J Bone Joint Surg Br. 2008;90(5):610-3.
Spencer EE, Kuhn JE. Biomechanical analysis of reconstructions for sternoclavicular joint instability. J Bone Joint Surg Am. 2004;86(1):98-105.
Burrows HJ. Tenodesis of subclavius in the treatment of recurrent dislocation of the sterno-clavicular joint. J Bone Joint Surg Br. 1951;33(2):240-3.
Rockwood CA, Groh GI, Wirth MA, Grassi FA. Resection arthroplasty of the sternoclavicular joint. J Bone Joint Surg Am. 1997;79(3):387-93.
Castropil W, Ramadan LB, Bitar AC, Schor B, de Oliveira D'Elia C. Sternoclavicular dislocation–reconstruction with semitendinosus tendon autograft: a case report. Knee Surg Sports Traumatol Arthrosc. 2008;16(9):865-8.