Long-term outcome after joint reconstruction or medial resection arthroplasty for anterior SCJ instability

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Abstract
In the present study, the long-term results of 11 patients with anterior sternoclavicular joint (SCJ) instability are reported. All included patients had an anterior SCJ instability and due to delayed diagnosis, operative treatment was not done immediately. The patients had a mean age of 29.2 years (range 16–63 years). One patient sustained concomitant injuries. Six patients had resection arthroplasty. Five patients had reconstruction of the SCJ with transosseous tension band PDS fixation or ligament reconstruction with additional wire cerclage. The results of treatment were evaluated after a mean follow-up period of 9.9 years (range 1–27 years) using the ASES, DASH and power-, age and gender adjusted Constant–Murley Score. In general, the mean values of the different scores (ASES 79.8; DASH 11.8; Constant–Murley 81%) demonstrated good outcome. The outcome evaluation of the patients who had SCJ reconstruction did not differ significantly from the patients who had medial resection arthroplasty. The rate of postoperative pain or instability was low using visual analog scale and did not differ significantly between the groups. The outcome results of the reconstruction group were equal to the results of the resection group when SCJ-reconstruction was performed soon after SCJ injury. One patient in the resection group (6 patients) demonstrated poor results due to continued instability of the remaining clavicle. We concluded that patient selection and a specific clinical indication for operative treatment are crucial. Resection of the medial clavicle results in good functional outcome when the costoclavicular ligament is preserved or reconstructed.

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