Arthroscopic Excision of the Sternoclavicular Joint

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.

Instabilitäten und Arthrose des Sternoklavikulargelenks

“…Regardless of the technique, in the current case series of treatment-refractory osteoarthritis of the SC joint, SC joint resection can generally achieve good clinical results, high patient satisfaction, and return to sports in over 80 % of cases [13,14,41,49,50,51,52].…”

“…As part of the evolution of arthroscopic techniques, an arthroscopic technique for SC joint resection was also described in 2009 by Tavakkolizadeh et al [48] and developed in recent years [14,41,49,50]. The potential strengths of the arthroscopic technique are essentially the conservation of the capsuloligamentous stabilisers of the SC joint, as well as improved visualisation and faster rehabilitation [2].…”

“…Regardless of whether open or arthroscopic, resection is usually performed in the lower two-thirds of the medial clavicle and, therefore, only in the joint-bearing part [14,41,49,50]. The upper third serves as an insertion for both the articular disc and for stabilising ligament structures of the SC joint and is left.…”

“…Im Rahmen der Evolution arthroskopischer Technik wurde auch eine solche für die SCG-Resektion 2009 von Tavakkolizadeh et al [48] beschrieben und in den letzten Jahren weiterentwickelt [14,41,49,50]. Als potenzielle Stärken der arthroskopischen Technik wird im Wesentlichen die Schonung der kapsuloligamentären Stabilisatoren des SCG, aber auch eine bessere Visualisierung und eine raschere Rehabilitation genannt [2].…”

“…Unabhängig davon, ob offen oder arthroskopisch vorgegangen wird, erfolgt die Resektion üblicherweise im Bereich der unteren ⅔ der medialen Klavikula und damit lediglich im Bereich des gelenktragenden Anteils [14,41,49,50]. Das obere Drittel dient als Insertion zum einen für den Discus articularis wie auch für stabilisierende SCG-Bandstrukturen und wird belassen.…”