Interposition Arthroplasty With Bone-Tendon Allograft: A Technique for Treatment of the Unstable Sternoclavicular Joint

Abstract

Sternoclavicular joint instability is an uncommon but challenging clinical problem for the orthopaedic surgeon. Although most cases can be treated nonoperatively with minimal long-term pain or functional limitation, a small percentage may require surgical intervention. This includes chronic anterior instability associated with persistent pain or functional limitation as well as irreducible or recurrent posterior instability. Although numerous procedures have been described for treatment of the unstable sternoclavicular joint, the optimal method for stabilization has not been determined. Here we describe a technique using Achilles tendon allograft to create an interpositional arthroplasty and briefly present 3 illustrative cases in which we performed the procedure. We believe this method effectively stabilizes the joint, restores function, relieves pain, and has applications for traumatic sternoclavicular instability as well as instability related to other etiologies.

Reconstruction for instability of the sternoclavicular joint using the tendon of the sternocleidomastoid muscle

“…[7][8][9][10][11] Double breasting the anterior capsule and reinforcing it with sutures passed through the bone and fixed either with anchors on one side or through drill holes on both sides has been described. 7,8 This is probably all that is required in the acute situation.…”

“…In acute presentations, stability can be successfully restored with sutures through the bone, bone anchors 7,8 or other techniques. [9][10][11] Surgical stabilisation of the recurrently unstable joint is difficult. Traditionally it has principally involved the use of periosteum or subclavius to secure the clavicle to the first rib with all the attendant risks and variable results.…”

Meniscectomy of the sternoclavicular joint: A report of two cases

“…A number of procedures have been described, including open reductioneinternal fixation, resection of the medial end of the clavicle, 24,28 SCJ reconstruction, 2,8 and more recently, interpositional arthroplasty. 3,21 However, significant complications, including device migration, 12,18,28 recurrent instability, nonunion, and bony erosion, 7,23,28 have been reported with surgery, and a preferred method has yet to be determined. To complicate matters, most of these techniques have been prescribed for patients with chronic SCJ pain and disability who had prior SCJ dislocations or fractures about the joint.…”

Arthroscopic excision of sternoclavicular joint

“…Treatment can be difficult and both conservative and surgical options have been used to stabilise the sternoclavicular joint with limited success [2,3].…”