title: Arthroscopy of the sternoclavicular joint: an anatomic evaluation of structures at risk.
abstract: BACKGROUND
  Recently, arthroscopy of the sternoclavicular joint (SCJ) has been described in clinical setting. The aim of this study is to examine the accessibility and safety of the SCJ by arthroscopy in a cadaveric model.
  
  
  METHODS
  An inferolateral and superomedial portal to the SCJ was created in 20 cadaveric specimens. After debridement, the specimens were dissected with a needle positioned in the portal tracts. The distance between the needles and bony landmarks, tendons and ligaments were measured. The integrity of the posterior capsule was evaluated macroscopically. In eight specimens, after anterior dissection, the needles were replaced by K-wires that perforated the posterior capsule to evaluate the distance to the neurovascular structures behind the SCJ.
  
  
  RESULTS
  Both portals were found to be safe while allowing good access to the joint. The superomedial portal went through the tendon of the sternocleidomastoideus muscle and the inferolateral portal through the pectoralis major muscle. The portals entered the capsule medial and lateral to the anterior sternoclavicular ligament. The posterior capsule was never perforated during debridement. The perforating K-wires, however, usually perforated either a major vein or artery, but were at a safe distance from the vagal nerve.
  
  
  CONCLUSIONS
  In this cadaver study, arthroscopy of the sternoclavicular joint could be used as a minimally invasive procedure allowing debridement of the joint without damaging the posterior capsule of the joint. If the capsule is inadvertently be breached, a major risk of neurovascular damage exists. We advise to have a backup of a cardiothoracic surgeon when performing this procedure.
authors.affiliation: Department of Orthopaedic Surgery and Traumatology, Ghent University Hospital, De Pintelaan 185, 9000, Ghent, Belgium, alexander.vantongel@uzgent.be.
authors.forename: Alexander
authors.initials: A
authors.lastname: Van Tongel
authors.forename: Tom
authors.initials: T
authors.lastname: Van Hoof
authors.forename: Nicole
authors.initials: N
authors.lastname: Pouliart
authors.forename: Philippe
authors.initials: P
authors.lastname: Debeer
authors.forename: Katharina
authors.initials: K
authors.lastname: D'Herde
authors.forename: Lieven
authors.initials: L
authors.lastname: De Wilde
mesh_terms: D001182:Arthroscopy / Q000379:methods*; D002102:Cadaver; D004210:Dissection; D006801:Humans; D013247:Sternoclavicular Joint / Q000033:anatomy & histology* / Q000601:surgery*