Single loop allograft reconstruction for sternoclavicular joint instability

Abstract

Background: Various surgical strategies have been used for the treatment of sternoclavicular joint instability with variable results. The purpose of this study was to report the clinical results of patients who underwent single-loop allograft reconstruction for sternoclavicular joint instability.

Methods: A total of 10 patients underwent single-loop allograft reconstruction for sternoclavicular joint instability from June 2012 to August 2014 by a single surgeon. All patients had a history of instability of the sternoclavicular joint with persistent chronic subluxation of the joint, magnetic resonance imaging disruption of the sternoclavicular ligaments, and persistent symptoms of pain and instability. Regarding the surgical technique, a single 5.5 mm drill hole was placed in the sternum and a second was placed in the medial aspect of the clavicle. A semitendinosus hamstring allograft was looped between the 2 holes and then tied in a square knot anteriorly. A #5 high-strength suture was used as cerclage as well. Nine of 10 patients (90% follow-up) were available at an average of 3.3 ± 0.84 years postoperatively. The average age of patients at the time of surgery was 42 years (range, 20-73 years). Patients were evaluated postoperatively with outcome scores (visual analog scale pain, American Shoulder and Elbow Surgeons, Simple Shoulder Test), a question regarding tenderness at the sternoclavicular joint, and a question regarding residual instability and overall patient satisfaction (yes/no).

Results: The average functional outcome scores for the Simple Shoulder Test, visual analog scale pain, and American Shoulder and Elbow Surgeons score were 11.8, 0.9, and 94.8, respectively. Three of 9 patients reported some residual tenderness located to the sternoclavicular joint. No patients reported any residual instability of the sternoclavicular joint. Eight of 9 patients reported that they were satisfied with the procedure. No patients required reoperation, and there were no complications.

Conclusion: Single-loop allograft reconstruction of the sternoclavicular joint provides reliable pain relief, functional improvement, and joint stability for patients with chronic sternoclavicular joint instability. The simplicity of the procedure eliminates the need for small, multiple drill holes that may lead to fracture between tunnels or the use of a small, thin graft.

Keywords: Allograft; clavicle; functional outcomes; loop; reconstruction; sternoclavicular joint instability.

Figure 1

Sternoclavicular joint reconstruction using one 5.5 mm tunnel in the sternum and one tunnel in the medial clavicle with #5 Fiberwire (Arthrex) cerclage.

Figure 2

Hockey stick incision over the sternoclavicular joint.

Figure 3

Two 5.5 mm tunnels created for loop reconstruction (1 in the sternum and 1 in the medial clavicle) with shuttling sutures placed.

Figure 4

Semitendinosus hamstring allograft passed from anterior to posterior through the sternal tunnel.

Figure 5

Posterior to anterior passage of the graft through the clavicular tunnel.

Figure 6

Tying of the high-strength suture cerclages between the sternal and clavicular tunnels.

Figure 7

Final reconstruction after the graft tied in a square knot.