Good Clinical and Functional Outcomes With Low Rates of Recurrent Instability and Revision Surgery After
Maximilian Hinz1, Daniel Kopolovich2, Bradley M Kruckeberg2
1Steadman Philippon Research Institute, Vail, Colorado, U.S.A.; Department of Sports Orthopaedics, Technical University of Munich, Munich, Germany.
Purpose:
To evaluate clinical and functional outcomes after sternoclavicular joint (SCJ) reconstruction or repair and to calculate the rates of recurrent instability, revision surgery, return to sport (RTS), and return to work (RTW) after SCJ reconstruction or repair for the treatment of SCJ instability.
Methods:
A systematic review of the literature based on the Preferred Reporting Items for Systematic Reviews and Meta Analyses was conducted using PubMed, Embase, and the Cochrane Library. Studies that evaluated the clinical and functional outcomes after SCJ reconstruction or repair for the treatment of SCJ instability were included. Data regarding study and patient characteristics, surgical management, clinical and functional outcomes as well as RTS and RTW were collected. Because of the heterogeneity of the studies included, patient-reported outcome measurements and complication rates were reported as ranges.
Results:
In total, ten studies (8 with Level IV evidence and 2 with Level III evidence) with 150 patients were included for analysis, of which a reconstruction was performed in 8 studies and a repair was performed in 2 studies. Mean patient age ranged from 22.2 to 42 years (range, 11-73 years), and the mean follow-up time ranged from mean 28.2 to 94.5 months (range, 24 months to 13 years). A traumatic event was the most common source for SCJ instability across all studies (43.8-100%). Surgery was performed more often for anterior SCJ instability than for posterior SCJ instability. The short version of the Disabilities of the Arm, Shoulder and Hand and American Shoulder and Elbow Surgeons scores were the most commonly reported functional outcome parameters and improved from mean 44.2 to 2.3-12.1 and 44.8-50.0 to 70.8-94.8, respectively. Pain (assessed via visual analog scale) decreased from mean 3.8-6.8 to 0-2.8 postoperatively. The recurrent instability rate was 0-10.0% and the revision SCJ surgery rate was 0-16.7%. Rates of RTS (44.4-100%) and RTW (42.9-75.0%) varied greatly among studies.
Conclusions:
Reconstruction or repair of the SCJ for the treatment of SCJ instability is associated with good-to-excellent clinical and functional outcomes, low rates of instability recurrence and of revision SCJ surgery, as well as moderate-to-high RTS and RTW rates.
Level Of Evidence:
Level IV, systematic review of Level III and IV studies.
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