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Clinical Outcome After Reconstruction for Sternoclavicular Joint Instability Using a Sternocleidomastoid Tendon Graft

Uri, Ofir MD; Barmpagiannis, Konstantinos MD; Higgs, Deborah FRCS; Falworth, Mark FRCS; Alexander, Susan FRCS, PhD; Lambert, Simon M. FRCS

Journal of Bone & Joint Surgery - American Volume: 5 March 2014 - Volume 96 - Issue 5 - p 417–422
doi: 10.2106/JBJS.M.00681
Scientific Articles

Background: Anterior instability of the sternoclavicular joint is uncommon and usually follows a benign course, although symptomatic patients may require surgical intervention. The optimal treatment for symptomatic instability of the sternoclavicular joint remains unclear. The aim of this study was to evaluate the clinical outcome after reconstruction of the sternoclavicular joint with use of a sternocleidomastoid tendon graft to treat chronic debilitating anterior instability of the sternoclavicular joint.

Methods: Thirty-two patients underwent surgical reconstruction of the sternoclavicular joint for chronic debilitating anterior instability using the tendon of the sternal head of the ipsilateral sternocleidomastoid muscle and were followed for a mean of forty-four months. The etiology of instability was posttraumatic in fourteen patients, generalized hyperlaxity in seven patients, and degenerative instability in eleven patients. Outcome measures included the Oxford instability shoulder score, subjective shoulder value, pain rating, and postoperative grading of sternoclavicular joint stability.

Results: Clinical scores and pain rating were similar for the three groups before surgery and improved significantly in all of the groups to the same extent after the surgery. At the time of the latest follow-up, eleven of fourteen patients in the posttraumatic group, six of seven patients in the generalized hyperlaxity group, and eight of eleven patients in the degenerative group reported the sternoclavicular joint as stable with no functional limitation. Two patients reported that the joint remained unstable. No other complications occurred.

Conclusions: Sternoclavicular joint reconstruction using a sternocleidomastoid tendon graft is safe and offers reliable pain relief and functional improvement for patients with chronic debilitating anterior instability of the sternoclavicular joint.

Level of Evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

1The Shoulder and Elbow Service, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, Middlesex, HA7 4LP, United Kingdom. E-mail address for O. Uri:

Copyright 2014 by The Journal of Bone and Joint Surgery, Incorporated
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