Primary osteoarthritis of the sternoclavicular joint: surgical management using the sternal docking technique

Dislocation of the sternoclavicular joint (SCJ) is the most common SCJ condition reported to be managed surgically. However, primary SCJ osteoarthritis (OA) is substantially more common. There are few reports in the literature on the outcome of surgical management of primary SCJ OA. We have successfully adopted sternal docking allograft reconstruction for SCJ instability and have now expanded the technique to patients with primary SCJ OA. This is our first report on the outcome of the sternal docking technique specifically for patients with primary SCJ OA.

Between 2012 and 2023, one fellowship trained shoulder surgeon consecutively performed surgical resection of the medial end of the clavicle and semitendinosus allograft ligament reconstruction using the sternal docking technique in 29 patients with SCJ OA. Seven patients were lost to follow-up (one declined participation, and 6 could not be contacted). The remaining 22 patients form the study cohort. There were 17 females and 5 males with a mean age of 49 ± 11 years at the time of surgery (range, 32-71 years). Their electronic medical records were reviewed to collect demographics, pain using a visual analog scale (VAS), complications and reoperations. Patients were also contacted at most recent follow-up to record VAS for pain, subjective shoulder value and American Shoulder and Elbow Surgeons shoulder score. The procedure was considered successful when patients experienced pain relief and did not develop any complications or required reoperation. The mean length of follow-up was 4 ± 3 (range, 1-12) years.

SCJ reconstruction was associated with significantly improved pain relief and overall shoulder function. Preoperatively, the mean VAS was 6 ± 1.5 (range, 4-9) points. At the most recent follow-up, the mean pain score was 0.5 ± 1.5 (range, 0-6) points, with median scores of 90 (interquartile range: 60-98) for subjective shoulder value and 80 (interquartile range: 70-81) points for American Shoulder and Elbow Surgeons. Twenty-one of 22 patients reported high satisfaction rates with their postoperative outcomes, with one patient endorsing partial satisfaction due to limited shoulder range of motion. Persistent peri-incisional numbness was reported by one patient. There were no re-operations at the time of the most recent follow-up.

Medial clavicle resection and ligament reconstruction seems to be associated with good overall outcomes, a high degree of patient satisfaction, and a low reoperation rate in patients with primary SCJ OA.