Long-term outcome after joint reconstruction or ... - ResearchGate

Arch Orthop Trauma Surg
Fig. 6 a 52-year female patient with cephalad displacement of the
right medial clavicle. This deformity is caused by the pull of the clavicular
head of the sternocleidomastoid muscle following resection
arthroplasty without maintenance of the costoclavicular ligament
(VAS instability 8; VAS pain 6). b Follow up X-ray 4 years after
resection of the medial end of the right clavicle. Cranial osteophytes at
the medial clavicle indicate the traction of the sternocleidomastoid
muscle
Other authors prefer PDS cord for SCJ Wxation using a
transosseous tension band technique. They describe good
functional and cosmetic results [17, 21].
Spencer et al. [39] described the biomechanical importance
of the posterior sternoclavicular joint capsule in preventing
anterior and posterior translation of the SCJ. The
anterior capsule acts as secondary stabilizer. Based on this
information, reconstruction of the anterior and posterior
joint capsules with Wgure-of-eight semitendinosus tendon
graft was developed. They have published a cadaveric biomechanical
study that demonstrates higher SCJ stiVness
using this semitendinosus Wgure-of-eight tendon reconstruction
in comparison to intramedullary tendon and subclavius
tendon reconstructions [39]. Unfortunately, in cases
with severe displacement, the soft tissue injury is so extensive
that repair of the capsule and costoclavicular ligaments
is hardly possible.
For old painful dislocations, failed SCJ reconstruction
and degenerative problems, resection of the medial end of
the clavicle is recommended [12, 34, 37]. In contrast, Eskola
et al. [14] reported good results following chronic SCJ
dislocations by stabilization with fascial loops or reconstruction
with a tendon graft. The authors do not recommend
resecting the sternal end of the clavicle due to poor
Fig. 7 a Intraoperative view of the SCJ. Following a skin incision parallel
to the superior clavicular border and caudad onto the anterior surface
of the manubrium, the periosteum is dissected carefully to
preserve the periostal tube and to protect the costoclavicular ligament.
b Intraoperative view after oblique resection of the medial clavicle.
The costoclavicular ligament has been left intact to maintain stability
of the medial clavicle in relation to the Wrst rib
results with pain and weakness of the upper extremity [14,
24].
On the other hand, Rockwood et al. [34] obtained satisfactory
results after resection arthroplasty of the SCJ. Fifteen
patients treated with resection of the medial clavicle
were evaluated retrospectively and were divided into two
groups. Eight patients who had had primary resection
arthroplasty in which the costoclavicular ligament was left
intact constituted group I. Group II was composed of seven
patients who had had revision of a failed resection arthroplasty
after reconstruction of the costoclavicular ligament.
The comparison was performed at an average of 7.7 years
postoperatively. All the eight patients in group I had excellent
results. Three patients in group II had an excellent
result, three hat fair results and one a poor result.
The authors pointed out that preservation or reconstruction
of the costoclavicular ligament is essential at the time
of resection arthroplasty in order to avoid cephalad pull on
the medial clavicle by the clavicular head of the sternocleidomastoid
muscle (Fig. 6a, b).
The crucial point of the medial resection technique is the
stabilization of the medial clavicular portion to the Wrst rib
(Fig. 7a, b) [7, 34].
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