gms | German Medical Science

Objectives: Sternoclavicular joint (SCJ) instability can lead to pain and reduced function. Surgical treatment may be indicated in patients with persistent symptoms despite to non-operative treatment. Reconstruction of the SCJ using hamstring autograft in a figure-of-eight configuration has demonstrated good outcomes at short- and mid-term follow-up, but there is a scarcity of literature on long-term outcomes. The purpose of the present study was to evaluate the long-term clinical and functional outcomes after SCJ reconstruction, with a special focus on recurrent instability and revision surgery rates.

Methods: Patients who underwent SCJ reconstruction with hamstring autograft for the treatment of SCJ instability from 12/2010–06/2013 by a single surgeon with a minimum 10 year follow-up were eligible for inclusion. Patient-reported outcome measures including the short version of the Disabilities of the Arm, Shoulder and Hand (QuickDASH) questionnaire, Single Assessment Numeric Evaluation (SANE), 12-Item Short-Form Health Survey Physical Component Summary (SF-12 PCS), and Visual Analog Scale (VAS) for pain, patient satisfaction (1–10 scale with “10” indicating maximum satisfaction), rates of instability-related modifications in recreational activity and survivorship (defined as absence of revision surgery) were evaluated.

Results and conclusion: Seventeen patients (64.7% male) with a mean age at the time of surgery of 28.8 ± SD 14.6 years met inclusion criteria. Complete data sets were obtained for thirteen patients (76.5%) at a mean of 11.1 ± 0.9 years postoperatively. Significant improvements in shoulder function (QuickDASH: 40.9 [interquartile range: 29.5–54.5] vs. 13.6 [6.8–15.9], p = .017; SANE: 40.0 [30.0–65.0] vs. 89.0 [79.0–94.0], p = .035), overall physical health (SF-12 PCS: 37.0 [35.6–47.3] vs. 55.2 [49.0–56.2], p = .017) and pain (VAS for pain: 4.5 vs 1.0, p =.013) were observed. Median satisfaction with the postoperative outcome was 9 [8–10]). Instability-related modifications of recreational activities were reported by 4 patients (30.8%). Revision surgery was performed in one patient, resulting in an overall survivorship of 92.3%. Sternoclavicular joint reconstruction using a hamstring autograft for the treatment of SCJ instability resulted in significant improvements in shoulder function, overall physical health and pain at long-term follow-up. Instability-related modifications in recreational activity were reported by 1 out of 3 patients, but revision surgery was rare.