Reconstruction of Chronic Anterior Sternoclavicular Joint Dislocations Using a Palmaris Longus Autograft

Abstract

BackgroundSternoclavicular 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.MethodsFive 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.ResultsThree 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%).DiscussionThe 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.