Sternoclavicular Joint Reconstruction Using the Sternal Docking Technique
Yazdan Raji1, Galvin J Loughran1, George Bugarinovic1
1Stanford University, Department of Orthopaedic Surgery, Redwood City, California, USA.
Background:
Sternoclavicular joint (SCJ) dislocations may occur as the result of traumatic injury, ligamentous laxity, or chronic arthropathy. While initial management of anterior sternoclavicular dislocations is typically nonoperative treatment, patients with symptomatic chronic dislocation may benefit from reconstruction. In this video, we describe the sternal docking technique for SCJ reconstruction using a semitendinosus allograft augmented with a biologic collagen scaffold.
Indications:
Current indications for SCJ reconstruction include acute posterior dislocations, symptomatic chronic anterior dislocations, and cases of symptomatic arthropathies of the SCJ.
Technique Description:
In a lazy beach-chair position, a curvilinear incision is made over the anterior SCJ centered over the inferior portion of the joint. After exposure of the joint, the intra-articular disc and 5 mm of medial clavicle are resected. A 4-mm bur is used to open the intramedullary canal on the articular facet of the manubrium and the medial clavicle. Additional perforations to act as tunnels are made on the anterior aspects of the manubrium and medial clavicle both superiorly and inferiorly, and a small curved curette is used to widen the tunnels and connect them to their respective intramedullary canals to allow for graft passage. The semitendinosus graft is whipstitched to a biologic collagen shoestring scaffold and passed through the tunnels. The joint is reduced, and the graft is sutured together over the top of the medial clavicle with appropriate tension.
Results:
The sternal docking technique was successfully implemented for the reconstruction of a chronic anterior SCJ dislocation and allowed the patient to return to full pain-free activity by 16 weeks.
Discussion:
Chronic anterior SCJ dislocations may fail to respond to conservative treatment measures necessitating operative reconstruction. The sternal docking technique using semitendinosus allograft augmented with a biologic shoestring scaffold described here is a safe and effective reconstructive technique.
Patient Consent Disclosure Statement:
The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.
