Resection arthroplasty of the sternoclavicular joint.

Department of Orthopaedics, The University of Texas Medical School at San Antonio, 78284-7774, USA.
The Journal of Bone and Joint Surgery (Impact Factor: 3.23). 04/1997; 79(3):387-93.
Source: PubMed

ABSTRACT The results of resection of the medial end of the clavicle to treat a painful sternoclavicular joint in fifteen patients were retrospectively reviewed. The patients fell into two groups: eight patients who had had a primary arthroplasty of the sternoclavicular joint in which the costoclavicular ligament was left intact (group I), and seven patients who had had revision of a failed arthroplasty of the sternoclavicular joint and in whom the costoclavicular ligament had to be reconstructed (group II). The results for these two groups were compared at an average of 7.7 years postoperatively. All eight patients in group I had an excellent result. In sharp contrast, three patients in group II had an excellent result, three had a fair result, and one had a poor result. We conclude that preservation or reconstruction of the costoclavicular ligament is essential at the time of resection of the medial portion of the clavicle in order to obtain a satisfactory result.

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    ABSTRACT: Symptomatic sternoclavicular joint arthritis is relatively uncommon. The majority of patients can be treated successfully by non-operative measures. However in a few patients, despite adequate non-operative treatment, symptoms persist. Open excision arthroplasty and, more recently, an arthroscopic technique have been described for the management of resistant cases. In this paper the anatomy and pathophysiology of sternoclavicular joint arthritis is described. The operative techniques and results of open excision arthroplasty are reviewed. The clinical results of most series are good although the case numbers are low. This in part may be to a relative reluctance to undertake surgery due to concerns with regards to potential damage to posterior mediastinal vascular structures. The results for arthroscopic sternoclavicular excision arthroplasty and the operative technique are described. The clinical results for the arthroscopic technique are comparable to the open series but with less peri-operative morbidity. Excision arthroplasty for patients with sternoclavicular arthritis resistant to non-operative measures is only considered rarely. However the results for open and arthroscopic excision arthroplasty, although from relatively small series, appear to be consistently good.
    Operative Techniques in Sports Medicine 09/2014; · 0.18 Impact Factor
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    ABSTRACT: Background Sternoclavicular joint (SCJ) injuries are uncommon. A minority of patients with anterior dislocation progress to chronic instability associated with pain and a limitation of activities, and thus surgery should be considered. A retrospective case series of an all anterior reconstruction of the SCJ with autologous palmaris longus is presented. Methods Five consecutive patients underwent SCJ stabilization using a palmaris longus autograft tunnelled through the anterior cortices of the medial clavicle and the manubrium sterni, avoiding posterior dissection of the SCJ and its associated risks. Results Three patients reported a completely stable SCJ after surgery at a mean 28 months postoperatively. One other patient reported improved stability and one reported recurrent instability. All patients had returned to work. The median Oxford Shoulder Score was 42 [interquartile range (IQR) 32 to 42] and the median Rockwood Score was 13 out of 15 (IQR 5 to 14). The median overall subjective satisfaction was 90% and, compared to the contralateral side, median satisfaction was also 90% (IQR 50% to 90%). Discussion The technique is safe and effective for reconstructing chronic anterior SCJ dislocations. The all anterior approach for reconstruction of the SCJ reduces the risk to the structures posterior to the medial clavicle, manubrium sterni or first rib.
    Shoulder & Elbow 04/2013; 5(2).
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    ABSTRACT: Open resection arthroplasty of the sternoclavicular (SC) joint has historically provided good long-term results in patients with symptomatic osteoarthritis of the SC joint. However, the procedure is rarely performed because of the risk of injury to vital mediastinal structures and concern regarding postoperative joint instability. Arthroscopic decompression of the SC joint has therefore emerged as a potential treatment option because of many recognized advantages including minimal tissue dissection, maintenance of joint stability, avoidance of posterior SC joint dissection, expeditious recovery, and improved cosmesis. There are, however, safety concerns given the proximity of neurovascular structures. In this article we demonstrate a technique for arthroscopic SC joint resection arthroplasty in a 26-year-old active man with bilateral, painful, idiopathic degenerative SC joint osteoarthritis. This case also highlights the pearls and pitfalls of arthroscopic resection arthroplasty for the SC joint. There were no perioperative complications. Four months postoperatively, the patient had returned to full activities, including weightlifting, without pain or evidence of SC joint instability. One year postoperatively, the patient showed substantial improvements in the American Shoulder and Elbow Surgeons score; Single Assessment Numeric Evaluation score; Quick Disabilities of the Arm, Shoulder and Hand score; and Short Form 12 Physical Component Summary score over preoperative baseline values.
    Arthroscopy techniques. 02/2014; 3(1):e165-73.

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