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Frank Martetschlager - One of the best experts on this subject based on the ideXlab platform.
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Sternoclavicular Joint reconstruction fracture risk is reduced with straight drill tunnels and optimized with tendon graft suture augmentation
Orthopaedic Journal of Sports Medicine, 2019Co-Authors: Coen A Wijdicks, Peter J Millett, Frank Martetschlager, Andreas B Imhoff, Franziska Reifenschneider, Nicole Fischer, Sepp BraunAbstract:Background:Despite the rare entity of Sternoclavicular Joint (SCJ) instability, a variety of different reconstruction techniques for SCJ dislocations have been described. A technique with oblique d...
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outcomes and complications following graft reconstruction for anterior Sternoclavicular Joint instability
Knee Surgery Sports Traumatology Arthroscopy, 2016Co-Authors: Lukas Willinger, Frank Martetschlager, Andreas B Imhoff, Jakob Schanda, Elmar HerbstAbstract:Publications describing tendon graft reconstruction for anterior Sternoclavicular Joint (SCJ) instability are rare and usually refer to small patient numbers. The aim of this study was to systematically review the literature regarding outcomes and complications following tendon graft reconstruction techniques for anterior SCJ instability. An online database was systematically searched to identify studies on graft reconstruction for anterior SCJ instability. Reported outcome scores were graded as excellent, good, fair and poor to summarize the study results. All reported complications were recorded. Five articles with a total of 80 patients met the inclusion criteria. Reported outcomes were excellent in 10 %, good in 89 % and fair in 1 %. Recurrent instability was found in 10 % of the patients, and 5 % underwent revision surgery due to persistent impairment of shoulder function related to SCJ instability or osteoarthritis. Surgical stabilization techniques for the SCJ using autologous tendon grafts have shown to be safe and reliable and make better patients’ pain situation and shoulder function. However, a certain amount of impairment might persist, which needs to be discussed with patients. Severe complications were rare and revision rates were as low as 5 %. Therefore, graft reconstruction techniques should be considered for patients with chronic anterior SCJ instability after a course of failed conservative treatment. This study is valuable for clinicians in daily clinical practice when dealing with this difficult-to-treat pathology and can help surgeons to better predict the clinical outcomes and complications following SCJ graft reconstruction. It should, however, not lead to underestimation of the potential risks of the procedure. Systematic review, Level IV.
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novel technique for Sternoclavicular Joint reconstruction using a gracilis tendon autograft
Knee Surgery Sports Traumatology Arthroscopy, 2016Co-Authors: Frank Martetschlager, Sepp Braun, Stephan Lorenz, Andreas Lenich, Andreas B ImhoffAbstract:Surgical treatment of Sternoclavicular Joint instability can be challenging and carries the inherent risk of damaging vital structures if the posterior capsule is violated during surgery. In the current manuscript, a novel and easy technique for open reduction and tendon graft stabilization of the unstable Sternoclavicular Joint is presented. Analogous to other techniques, the graft is passed through drill holes in a figure-of-eight configuration. However, for this technique, the drill holes are placed in oblique direction from the anterior cortex towards the articular surface of the sternum, respectively the medial clavicle. By doing so, graft reconstruction is achieved without any need for retrosternal dissection and mobilization of the posterior capsule, thus minimizing the risk of severe intraoperative complications. V.
Graham Tytherleighstrong - One of the best experts on this subject based on the ideXlab platform.
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the Sternoclavicular Joint
2019Co-Authors: Graham TytherleighstrongAbstract:The Sternoclavicular Joint (SCJ) is the only bony connection between the upper limb and the axial skeleton. It is also the Joint with the least bony congruency in the body, yet it is extremely stable thanks to a strong stabilising soft-tissue envelope of ligaments, muscles and tendons. Due to its central position and the strong stabilising envelope, injury and pathology around the SCJ is uncommon.
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swellings of the Sternoclavicular Joint review of traumatic and non traumatic pathologies
EFORT Open Reviews, 2018Co-Authors: J Edwin, Graham Tytherleighstrong, Shahbaz Ahmed, Shobhit Verma, Karthik Karuppaiah, Joydeep SinhaAbstract:The Sternoclavicular Joint (SCJ) is an integral part of the shoulder girdle that connects the upper limb to the axial skeleton.Swelling of the SCJ is commonly due to trauma, degeneration, infections and other disease processes that affect synovial Joints.This review also focuses on uncommon conditions that could affect the SCJ, including SAPHO (synovitis, acne, pustulosis, hyperostosis, osteitis) syndrome, Friedrich's disease and Tietze syndrome.The scope of this review is limited to the analysis of the current evidence on the various conditions affecting the SCJ and also to provide an algorithm to manage these conditions. Cite this article: EFORT Open Rev 2018;3:471-484. DOI: 10.1302/2058-5241.3.170078.
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arthroscopic excision of the Sternoclavicular Joint
Arthroscopy techniques, 2017Co-Authors: Graham Tytherleighstrong, Lee Van RensburgAbstract:Osteoarthritis changes at the Sternoclavicular Joint (SCJ) have been shown to be present on computed tomography in more than 90% of people over the age of 60 years. Although usually asymptomatic, when symptoms do occur, they can be very debilitating. Most patients respond favorably to conservative treatment, but there is a small cohort of patients who continue to be symptomatic despite adequate conservative treatment. Surgical management with an open SCJ excision has been shown to give satisfactory results. However, probably due to concerns with regard to damage to the mediastinal structures, instability, and scarring, there is a high threshold for surgery. Arthroscopic SCJ excision has been shown to achieve similar results to an open procedure while avoiding some of the risks. In this Technical Note, we describe the indications, imaging, and the technique of an arthroscopic excision of the SCJ.
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arthroscopic intra articular disk excision of the Sternoclavicular Joint
Arthroscopy techniques, 2017Co-Authors: Graham Tytherleighstrong, Christopher Lawrence, Abbas Rashid, David MorrisseyAbstract:Abstract The Sternoclavicular Joint (SCJ) has a complete intra-articular disk that can be damaged either as a result of trauma or as part of ongoing degenerative Joint disease. Although often asymptomatic, SCJ disk tears may lead to mechanical symptoms and pain. Previously, isolated symptomatic SCJ disk tears have only occasionally been mentioned in the literature with a few associated case reports of diskectomy by open arthrotomy. With improved imaging and availability of magnetic resonance imaging scans and the advent of SCJ arthroscopy it is now possible to treat symptomatic SCJ disk tears by arthroscopic excision. In this Technical Note, we describe the diagnosis of a torn SCJ disk and the technique of arthroscopic excision of a torn SCJ disk.
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the prevalence of osteoarthritis of the Sternoclavicular Joint on computed tomography
Journal of Shoulder and Elbow Surgery, 2017Co-Authors: Christopher Lawrence, Abbas Rashid, Benjamin East, Graham TytherleighstrongAbstract:Background Symptomatic disorders around the Sternoclavicular Joint (SCJ) are relatively uncommon. Previous cadaveric and radiographic studies have suggested that asymptomatic osteoarthritic changes are relatively common, progressively increasing with age. The purpose of this study was to determine the prevalence of SCJ osteoarthritis in the general population using computed tomography (CT) scans. Methods We assessed 464 SCJs in 232 patients undergoing a standardized axial CT scan of the thorax including both SCJs, across a range of ages from the second to tenth decade. The scans were undertaken for multiple clinical indications; however, none were obtained to investigate SCJ pathology. The predominant changes investigated were for the features associated with osteoarthritis including the presence of osteophytes, subchondral cysts, and subcortical sclerosis. Results The CT scans of 244 SCJs (53%) in 137 patients (59%) showed at least 1 sign of osteoarthritis. No patients younger than 35 years had any features of osteoarthritis. Osteoarthritic changes were present in 89.6% of patients older than 50 years compared with 9.1% younger than this age. All patients above the age of 61 had at least 1 feature of osteoarthritic changes on at least 1 side of the SCJ. Increasing prevalence was noted with increasing age both in the percentage of SCJs showing any positive signs of osteoarthritis and in the severity of osteoarthritis. Conclusion SCJ osteoarthritis is a very common incidental finding on CT scans, particularly with increasing age. This should be taken into consideration when using a CT scan to assess a patient with symptomatic SCJ pathology.
Andreas B Imhoff - One of the best experts on this subject based on the ideXlab platform.
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Sternoclavicular Joint reconstruction fracture risk is reduced with straight drill tunnels and optimized with tendon graft suture augmentation
Orthopaedic Journal of Sports Medicine, 2019Co-Authors: Coen A Wijdicks, Peter J Millett, Frank Martetschlager, Andreas B Imhoff, Franziska Reifenschneider, Nicole Fischer, Sepp BraunAbstract:Background:Despite the rare entity of Sternoclavicular Joint (SCJ) instability, a variety of different reconstruction techniques for SCJ dislocations have been described. A technique with oblique d...
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outcomes and complications following graft reconstruction for anterior Sternoclavicular Joint instability
Knee Surgery Sports Traumatology Arthroscopy, 2016Co-Authors: Lukas Willinger, Frank Martetschlager, Andreas B Imhoff, Jakob Schanda, Elmar HerbstAbstract:Publications describing tendon graft reconstruction for anterior Sternoclavicular Joint (SCJ) instability are rare and usually refer to small patient numbers. The aim of this study was to systematically review the literature regarding outcomes and complications following tendon graft reconstruction techniques for anterior SCJ instability. An online database was systematically searched to identify studies on graft reconstruction for anterior SCJ instability. Reported outcome scores were graded as excellent, good, fair and poor to summarize the study results. All reported complications were recorded. Five articles with a total of 80 patients met the inclusion criteria. Reported outcomes were excellent in 10 %, good in 89 % and fair in 1 %. Recurrent instability was found in 10 % of the patients, and 5 % underwent revision surgery due to persistent impairment of shoulder function related to SCJ instability or osteoarthritis. Surgical stabilization techniques for the SCJ using autologous tendon grafts have shown to be safe and reliable and make better patients’ pain situation and shoulder function. However, a certain amount of impairment might persist, which needs to be discussed with patients. Severe complications were rare and revision rates were as low as 5 %. Therefore, graft reconstruction techniques should be considered for patients with chronic anterior SCJ instability after a course of failed conservative treatment. This study is valuable for clinicians in daily clinical practice when dealing with this difficult-to-treat pathology and can help surgeons to better predict the clinical outcomes and complications following SCJ graft reconstruction. It should, however, not lead to underestimation of the potential risks of the procedure. Systematic review, Level IV.
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novel technique for Sternoclavicular Joint reconstruction using a gracilis tendon autograft
Knee Surgery Sports Traumatology Arthroscopy, 2016Co-Authors: Frank Martetschlager, Sepp Braun, Stephan Lorenz, Andreas Lenich, Andreas B ImhoffAbstract:Surgical treatment of Sternoclavicular Joint instability can be challenging and carries the inherent risk of damaging vital structures if the posterior capsule is violated during surgery. In the current manuscript, a novel and easy technique for open reduction and tendon graft stabilization of the unstable Sternoclavicular Joint is presented. Analogous to other techniques, the graft is passed through drill holes in a figure-of-eight configuration. However, for this technique, the drill holes are placed in oblique direction from the anterior cortex towards the articular surface of the sternum, respectively the medial clavicle. By doing so, graft reconstruction is achieved without any need for retrosternal dissection and mobilization of the posterior capsule, thus minimizing the risk of severe intraoperative complications. V.
Winston J Warme - One of the best experts on this subject based on the ideXlab platform.
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unicortical sternal graft reconstruction for anterior Sternoclavicular Joint instability
Case Reports, 2021Co-Authors: Kate M Parker, Jeremy S Somerson, Winston J WarmeAbstract:Sternoclavicular Joint (SCJ) injury represents 3%–5% of all shoulder girdle injuries, yet can produce significant pain and disability. While conservative management improves symptoms in most cases, surgical intervention may be indicated for patients with symptoms recalcitrant to nonoperative treatment. A wide range of surgical stabilisation techniques is documented in the literature; however, the scarcity of SCJ pathology has hindered development of a ‘gold standard’. We present a minimalistic medial clavicle osteoplasty and SCJ reconstruction using semitendinosus autograft anchored with unicortical sternal tunnels in the 54 years old with chronic SCJ instability. This technique can be performed safely, resulting in Joint stability and pain reduction, while avoiding risks and complications noted in the literature with other techniques.
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corr insights surgical technique results of stabilization of Sternoclavicular Joint luxations using a polydioxanone envelope plasty
Clinical Orthopaedics and Related Research, 2013Co-Authors: Winston J WarmeAbstract:Where Are We Now?Sternoclavicular Joint instability problems generally areavoided by orthopaedic surgeons. Many consider thisregion to be the purview of thoracic surgeons, given theproximity to the great vessels in the mediastinum. How-ever, patients often visit orthopaedic surgeons for recurrentinstability of this Joint or for symptomatic Sternoclaviculararthritis. We usually start with nonoperative approaches,but surgery sometimes enters the conversation. What is thebest surgical procedure for Sternoclavicular Joint instabil-ity? The answer is difficult to discern considering injuriesto this Joint are rather rare. Large clinical trials do not exist,but the literature is replete with case reports and case ser-ies. We may seek guidance from the biomechanicsliterature; if so, the work of Spencer and Kuhn [2] is per-haps most relevant. They compared a tendon weave withtwo other reported stabilization techniques: subclaviustenodesis and the Rockwood technique. They found thetendon weave to be the strongest stabilization technique,but this approach involved bicortical drilling through thesternum and medial clavicle, which is not in the ‘‘wheel-house’’ of most orthopaedic surgeons—even those withshoulder and elbow fellowship training.Where Do We Need to Go?The technique described by Gardeniers and colleagues is anovel approach to address Sternoclavicular Joint instability.That said, the use of polydioxyanone (PDS) in and aroundthe shoulder girdle is not new. The material has been usedin early transglenoid capsulorraphies for glenohumeralinstability and to stabilize high-grade acromioclavicu-lar Joint separations with a coracoclavicular cerclage. Italso has been used to stabilize acute Sternoclavicular Jointdislocations using the ‘‘safe’’ technique described byThomas et al. [3]. The ‘‘safe’’ technique, like the techniquedescribed by Gardeniers et al., is intriguing. It avoidspenetration of the dorsal surfaces of the sternum andclavicle and similarly obviates the risk of mediastinalinjury. However, eight of 39 patients in the current studyhad recurrent instability, which somewhat decreases one’senthusiasm to use this technique.How Do We Get There?The ideal approach would be an appropriately powered andrandomized clinical trial comparing the tendon graft figure-of-eight reconstruction, the PDS-envelop plasty, and the‘‘safe’’ method. This would need to be a multicenter study,as these cases are not particularly common. However, until
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posterior dislocation of the Sternoclavicular Joint
Radiology Case Reports, 2011Co-Authors: Leila Khorashadi, Erica M Burns, Daniel R Heaston, Winston J Warme, Michael L RichardsonAbstract:Posterior dislocation of the Sternoclavicular Joint is a rare but serious and life-threatening injury. Case reports describing injury to mediastinal structures including the trachea, esophagus, and the great vessels from posterior displacement of the medial clavicle (1, 2, 3, 4, 5, 6) have been discussed in the literature. It is important that radiologists are aware of the limitation of plain radiographs in detecting posterior SCJ dislocation and and that they carefully evaluate the soft tissues with CT imaging to exclude mediastinal injury.
Michael A Wirth - One of the best experts on this subject based on the ideXlab platform.
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management of traumatic Sternoclavicular Joint injuries
Journal of The American Academy of Orthopaedic Surgeons, 2011Co-Authors: Gordon I Groh, Michael A WirthAbstract:Traumatic Sternoclavicular Joint injuries account for <3% of all traumatic Joint injuries. Proper recognition and treatment are vital because these injuries may be life threatening. Injuries are classified according to patient age, severity, and, in the setting of dislocation, the direction of the medial clavicle. Anterior injuries are far more common than posterior injuries. Posterior dislocation may be associated with complications such as dyspnea, dysphagia, cyanosis, and swelling of the ipsilateral extremity as well as paresthesia associated with compression of the trachea, esophagus, or great vessels. These life-threatening complications may present at the time of injury but can develop later, as well. Radiography has been largely supplanted by CT for evaluation of this injury, although an oblique view developed by Wirth and Rockwood is useful in evaluating isolated Sternoclavicular injury. MRI is useful in differentiating physeal injury from Sternoclavicular dislocation in patients aged<23 years.
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Sternoclavicular Joint swelling after surgery of the head and neck region a case report and differential diagnostic review
American Journal of Otolaryngology, 2001Co-Authors: Michael B Gluth, Blake C Simpson, Michael A WirthAbstract:Abstract Background: Very few published reports in the otolaryngologic literature discuss Sternoclavicular Joint swelling encountered in the postoperative setting. Methods: The authors document a case of Sternoclavicular Joint swelling after medialization laryngoplasty. This report is supplemented with a review of the medical literature related to pertinent conditions affecting the Sternoclavicular Joint. Conclusions: In our patient, swelling was thought to be related to Joint trauma experienced during surgery secondary to standard shoulder roll extension in a patient with preexisting postmenopausal arthritis. This case stands in contrast to the body of documented cases of postoperative Sternoclavicular swelling in which the surgical procedure itself was responsible for such findings. (Am J Otolaryngol 2001;22;367-370. Copyright © 2001 by W.B. Saunders Company)
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resection arthroplasty of the Sternoclavicular Joint
Journal of Bone and Joint Surgery American Volume, 1997Co-Authors: Charles A Rockwood, Michael A Wirth, Gordon I Groh, F A GrassiAbstract:The results of resection of the medial end of the clavicle to treat a painful Sternoclavicular Joint in fifteen patients were retrospectively reviewed. The patients fell into two groups: eight patients who had had a primary arthroplasty of the Sternoclavicular Joint in which the costoclavicular ligament was left intact (group I), and seven patients who had had revision of a failed arthroplasty of the Sternoclavicular Joint and in whom the costoclavicular ligament had to be reconstructed (group II). The results for these two groups were compared at an average of 7.7 years postoperatively. All eight patients in group I had an excellent result. In sharp contrast, three patients in group II had an excellent result, three had a fair result, and one had a poor result. We conclude that preservation or reconstruction of the costoclavicular ligament is essential at the time of resection of the medial portion of the clavicle in order to obtain a satisfactory result.
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acute and chronic traumatic injuries of the Sternoclavicular Joint
Journal of The American Academy of Orthopaedic Surgeons, 1996Co-Authors: Michael A Wirth, Charles A RockwoodAbstract:Acute and chronic traumatic injuries of the Sternoclavicular Joint require accurate diagnosis and management if complications are to be avoided. Sternoclavicular subluxation or dislocation, medial-clavicle physeal injuries, and degenerative arthritis are the most frequently diagnosed of these relatively uncommon injuries. The medial clavicular epiphysis does not ossify until the 18th to 20th year. Knowledge of its developmental anatomy is essential because most physeal injuries will heal with time without surgical intervention. In contrast, posterior dislocation of the Sternoclavicular Joint requires prompt closed or open reduction, as posterior displacement of the medial clavicle has been associated with numerous complications, including respiratory distress, venous congestion or arterial insufficiency, brachial plexus compression, and myocardial conduction abnormalities. A myriad of procedures have been recommended for repair or reconstruction of the Sternoclavicular Joint. On the basis of the authors’ experience and review of the literature, they advocate surgical resection of the medial clavicle, with maintenance, repair, or reconstruction of the costoclavicular ligaments, when surgery is indicated. Metallic-pin fixation of the Joint should be avoided, as Steinmann pins, Kirschner wires, threaded pins with bent ends, and Hagie pins have all been reported to migrate and cause serious complications, including death. J Am Acad Orthop Surg 1996;4:268-278
