title: Clinical outcome after reconstruction for sternoclavicular joint instability using a sternocleidomastoid tendon graft.
abstract: BACKGROUND
  Anterior instability of the sternoclavicular joint is uncommon and usually follows a benign course, although symptomatic patients may require surgical intervention. The optimal treatment for symptomatic instability of the sternoclavicular joint remains unclear. The aim of this study was to evaluate the clinical outcome after reconstruction of the sternoclavicular joint with use of a sternocleidomastoid tendon graft to treat chronic debilitating anterior instability of the sternoclavicular joint.
  
  
  METHODS
  Thirty-two patients underwent surgical reconstruction of the sternoclavicular joint for chronic debilitating anterior instability using the tendon of the sternal head of the ipsilateral sternocleidomastoid muscle and were followed for a mean of forty-four months. The etiology of instability was posttraumatic in fourteen patients, generalized hyperlaxity in seven patients, and degenerative instability in eleven patients. Outcome measures included the Oxford instability shoulder score, subjective shoulder value, pain rating, and postoperative grading of sternoclavicular joint stability.
  
  
  RESULTS
  Clinical scores and pain rating were similar for the three groups before surgery and improved significantly in all of the groups to the same extent after the surgery. At the time of the latest follow-up, eleven of fourteen patients in the posttraumatic group, six of seven patients in the generalized hyperlaxity group, and eight of eleven patients in the degenerative group reported the sternoclavicular joint as stable with no functional limitation. Two patients reported that the joint remained unstable. No other complications occurred.
  
  
  CONCLUSIONS
  Sternoclavicular joint reconstruction using a sternocleidomastoid tendon graft is safe and offers reliable pain relief and functional improvement for patients with chronic debilitating anterior instability of the sternoclavicular joint.
authors.affiliation: The Shoulder and Elbow Service, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, Middlesex, HA7 4LP, United Kingdom. E-mail address for O. Uri: ofiruri@gmail.com.
authors.forename: Ofir
authors.initials: O
authors.lastname: Uri
authors.affiliation: The Shoulder and Elbow Service, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, Middlesex, HA7 4LP, United Kingdom. E-mail address for O. Uri: ofiruri@gmail.com.
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Barmpagiannis
authors.affiliation: The Shoulder and Elbow Service, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, Middlesex, HA7 4LP, United Kingdom. E-mail address for O. Uri: ofiruri@gmail.com.
authors.forename: Deborah
authors.initials: D
authors.lastname: Higgs
authors.affiliation: The Shoulder and Elbow Service, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, Middlesex, HA7 4LP, United Kingdom. E-mail address for O. Uri: ofiruri@gmail.com.
authors.forename: Mark
authors.initials: M
authors.lastname: Falworth
authors.affiliation: The Shoulder and Elbow Service, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, Middlesex, HA7 4LP, United Kingdom. E-mail address for O. Uri: ofiruri@gmail.com.
authors.forename: Susan
authors.initials: S
authors.lastname: Alexander
authors.affiliation: The Shoulder and Elbow Service, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, Middlesex, HA7 4LP, United Kingdom. E-mail address for O. Uri: ofiruri@gmail.com.
authors.forename: Simon M
authors.initials: SM
authors.lastname: Lambert
mesh_terms: D000293:Adolescent; D000328:Adult; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007593:Joint Instability / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019637:Orthopedic Procedures / Q000379:methods; D012189:Retrospective Studies; D013247:Sternoclavicular Joint; D013710:Tendons / Q000637:transplantation*; D016896:Treatment Outcome; D055815:Young Adult