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: 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.
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