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.

Keywords: instability; internal brace; stabilization; sternoclavicular joint.

Figure 1.

T2-weighted coronal and axial magnetic resonance imaging scans of the sternoclavicular joints 48 hours after a left traumatic anterior dislocation that has been reduced. There is a significant effusion with a tear to the left interclavicular ligament and to the anterior capsule.

Figure 2.

Intraoperative photograph and diagram of an open repair of the anterior sternoclavicular joint capsule. The capsule has been opened longitudinally, and two No. 5 sutures (A-A, B-B) have been passed through the edges of the capsule and doubled over.

Figure 3.

Intraoperative photograph and diagram of an open repair of the anterior sternoclavicular joint capsule. The 2 central sutures have been tied, and further sutures have been tied at either end of the capsular split.

Figure 4.

A diagram and a postoperative axial computed tomography scan of the left sternoclavicular joint. The 3.5-mm SwiveLock anchor has been inserted at an angle into the sternum, and the 4.5-mm SwiveLock has been inserted perpendicularly into the medial end of the clavicle with the FiberTape secured between them.

Figure 5.

Intraoperative photograph and diagram of an open repair of the anterior sternoclavicular joint capsule. The anchors for the InternalBrace have been inserted into the sternum and medial end of the clavicle with the 2 strands of FiberTape tensioned between them.

Figure 6.

Postoperative 3D computed tomography reconstruction of the anterior chest wall demonstrating the reduced left sternoclavicular joint with the anchor entry holes visible.