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Reconstruction of chronic anterior sternoclavicular joint dislocations using a Palmaris longus autograft

References: Shoulder & Elbow Journal 2012


Background:
Sternoclavicular joint (SCJ) injuries are uncommon. A minority of patients with anterior dislocation progress to chronic instability associated with pain and limitation of activities and surgery should be considered. A retrospective case series of an all anterior reconstruction of the SCJ with autologous palmaris longus is presented.

Methods:
Five consecutive patients underwent SCJ stabilization using a palmaris longus autograft tunneled through the anterior cortices of the medial clavicle and the manubrium sterni, avoiding posterior dissection of the SCJ and its associated risks. 

Results:
Four patients reported a stable SCJ following surgery at a mean 28 months post-operatively. All patients had returned to work. The median Oxford Shoulder Score was 42 (inter-quartile range 32-42), the median Rockwood score was 13 out of 15 (IQR 5-14). The median overall subjective satisfaction was 90% and when compared to the contralateral side the satisfaction was also 90% (IQR 50-90).  

Discussion:
The technique is safe and effective in reconstructing chronic anterior sternoclavicular joint 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.

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