title: Reconstruction of the chronic anterior unstable sternoclavicular joint using a tendon autograft: medium-term to long-term follow-up results.
abstract: BACKGROUND
  Chronic symptomatic anterior sternoclavicular (SC) instability is a rare condition with sparse treatment options. Owing to the rarity of the condition and the potential risk of fatal complications, only a few reports on treatment of this condition have been published. We evaluated a prospective series of patients with chronic anterior SC instability who underwent minimally open reconstruction with an autologous tendon graft.
  
  
  METHODS
  From 2002 to 2010, 32 consecutive patients underwent minimally open SC ligament reconstruction using a tendon autograft. A palmaris longus was used in 7 patients and a gracilis tendon autograft was used in 25. All patients with at least 2 years of follow-up were reviewed. Five were lost to follow-up. The remaining 27 patients (84.4%) were a median age of 35 years (range, 11-61 years) at surgery. Patients were evaluated with the Western Ontario Shoulder Instability (WOSI) score preoperatively and at follow-up at a median 54 months (range, 24-120 months) postoperatively.
  
  
  RESULTS
  The total WOSI score improved from a median of 44% (range 6%-62%) preoperatively to 75% (range, 13%-93%) at follow-up (P = .0001). Two failures (7.4%) occurred; after revision, both patients remained stable. After the operation, 17 of 25 patients (68%) complained of donor site morbidity, and 10 (40%) still had some discomfort at follow-up. No infections or local vascular complications occurred.
  
  
  CONCLUSIONS
  Miniopen SC joint reconstruction using a tendon autograft results in prolonged improvement in shoulder function in most patients with symptomatic anterior SC instability.
authors.affiliation: Parkens Privathospital, Copenhagen, Denmark. Electronic address: kb@teres.dk.
authors.forename: Klaus
authors.initials: K
authors.lastname: Bak
authors.affiliation: Parkens Privathospital, Copenhagen, Denmark.
authors.forename: Kamille
authors.initials: K
authors.lastname: Fogh
mesh_terms: D000293:Adolescent; D000328:Adult; D064592:Autografts; D002648:Child; D002908:Chronic Disease; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D004204:Joint Dislocations / Q000601:surgery*; D007593:Joint Instability / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D019651:Plastic Surgery Procedures / Q000379:methods; D013247:Sternoclavicular Joint / Q000293:injuries / Q000601:surgery*; D013710:Tendons / Q000637:transplantation*; D055815:Young Adult
keywords: Case Series; Level IV; Sternoclavicular joint; Treatment Study; instability; reconstruction; tendon autograft