title: Surgical anatomy of the sternoclavicular joint: a qualitative and quantitative anatomical study.
abstract: BACKGROUND
  The quantitative anatomical relationships of the main ligamentous, tendinous, and osseous structures of the sternoclavicular joint have not been widely investigated. The purpose of this study was to provide a quantitative description of the sternoclavicular joint in relation to relevant surgical landmarks.
  
  
  METHODS
  We dissected eleven nonpaired, fresh-frozen cadaveric sternoclavicular joints from four men and seven women (mean age at death, fifty-three years; range, thirty-three to sixty-four years) and measured the ligaments, musculature, and osseous landmarks with use of a three-dimensional coordinate-measuring device.
  
  
  RESULTS
  The clavicular pectoralis ridge, located at the 9:30 clock-face position on a right clavicle, served as a reliable osseous landmark for reference to the soft-tissue attachments around the sternoclavicular joint. The costoclavicular ligament was the largest ligament of the sternoclavicular joint, with 80% greater footprint area than that of the posterior sternoclavicular ligament. Articular cartilage covered 67% of the medial end of the clavicle and was located anteroinferiorly. The sternohyoid muscle inserted directly over the posterior sternoclavicular joint and the medial end of the clavicle, whereas the sternothyroid muscle inserted 9.5 mm inferior to the posterior-superior articular margin of the manubrium and coursed 19.8 mm laterally along the first rib. An avascular plane that can serve as a "safe zone" for posterior dissection was observed in each specimen, posterior to the sternoclavicular joint and anterior to the sternohyoid and sternothyroid muscles.
  
  
  CONCLUSIONS
  The clavicular pectoralis ridge can be used as an intraoperative guide for clavicle orientation and tunnel placement in sternoclavicular ligament reconstruction. Sternoclavicular joint resection arthroplasty should avoid injuring the costoclavicular ligament, which is the largest sternoclavicular joint ligament. Resection of only the anteroinferior aspect of the medial end of the clavicle may provide adequate decompression while preserving the stability of the clavicle. The location of the sternohyoid and sternothyroid musculotendinous insertions appear to provide a "safe zone" for posterior clavicle and manubrial dissection.
authors.affiliation: Steadman Philippon Research Institute, 181 West Meadow Drive, Suite #1000, Vail, CO 81657. E-mail address for P.J. Millett: drmillett@thesteadmanclinic.com.
authors.forename: Jared T
authors.initials: JT
authors.lastname: Lee
authors.affiliation: Steadman Philippon Research Institute, 181 West Meadow Drive, Suite #1000, Vail, CO 81657. E-mail address for P.J. Millett: drmillett@thesteadmanclinic.com.
authors.forename: Kevin J
authors.initials: KJ
authors.lastname: Campbell
authors.affiliation: Steadman Philippon Research Institute, 181 West Meadow Drive, Suite #1000, Vail, CO 81657. E-mail address for P.J. Millett: drmillett@thesteadmanclinic.com.
authors.forename: Max P
authors.initials: MP
authors.lastname: Michalski
authors.affiliation: Steadman Philippon Research Institute, 181 West Meadow Drive, Suite #1000, Vail, CO 81657. E-mail address for P.J. Millett: drmillett@thesteadmanclinic.com.
authors.forename: Katharine J
authors.initials: KJ
authors.lastname: Wilson
authors.affiliation: Steadman Philippon Research Institute, 181 West Meadow Drive, Suite #1000, Vail, CO 81657. E-mail address for P.J. Millett: drmillett@thesteadmanclinic.com.
authors.forename: Ulrich J A
authors.initials: UJ
authors.lastname: Spiegl
authors.affiliation: Steadman Philippon Research Institute, 181 West Meadow Drive, Suite #1000, Vail, CO 81657. E-mail address for P.J. Millett: drmillett@thesteadmanclinic.com.
authors.forename: Coen A
authors.initials: CA
authors.lastname: Wijdicks
authors.affiliation: Steadman Philippon Research Institute, 181 West Meadow Drive, Suite #1000, Vail, CO 81657. E-mail address for P.J. Millett: drmillett@thesteadmanclinic.com.
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Millett
mesh_terms: D002102:Cadaver; D002968:Clavicle / Q000033:anatomy & histology; D005260:Female; D006801:Humans; D008022:Ligaments / Q000033:anatomy & histology; D008297:Male; D008875:Middle Aged; D009132:Muscles / Q000033:anatomy & histology; D010369:Pectoralis Muscles / Q000033:anatomy & histology; D013247:Sternoclavicular Joint / Q000033:anatomy & histology* / Q000601:surgery