Outcomes and complications following graft reconstruction for anterior sternoclavicular joint instability.
OBJECTIVE
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.


METHODS
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.


RESULTS
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.


CONCLUSIONS
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.


METHODS
Systematic review, Level IV.
Department of Orthopaedic Sports Medicine, Klinikum Rechts der Isar, Technical University Munich, Ismaningerstr. 22, 81675, Munich, Germany.
Lukas
L
Willinger
Department of Orthopaedic Sports Medicine, Klinikum Rechts der Isar, Technical University Munich, Ismaningerstr. 22, 81675, Munich, Germany.
Jakob
J
Schanda
Department of Orthopaedic Sports Medicine, Klinikum Rechts der Isar, Technical University Munich, Ismaningerstr. 22, 81675, Munich, Germany.
Elmar
E
Herbst
Department of Orthopaedic Sports Medicine, Klinikum Rechts der Isar, Technical University Munich, Ismaningerstr. 22, 81675, Munich, Germany. a.imhoff@lrz.tu-muenchen.de.
Andreas B
AB
Imhoff
Department of Orthopaedic Sports Medicine, Klinikum Rechts der Isar, Technical University Munich, Ismaningerstr. 22, 81675, Munich, Germany.|Deutsches Schulterzentrum, ATOS Clinic Munich, Effnerstr. 38, 81925, Munich, Germany.
Frank
F
Martetschläger
D064592:Autografts; D006801:Humans; D007593:Joint Instability / Q000601:surgery*; D019637:Orthopedic Procedures / Q000379:methods; D010003:Osteoarthritis / Q000601:surgery; D019651:Plastic Surgery Procedures / Q000379:methods; D012008:Recurrence; D012086:Reoperation; D013247:Sternoclavicular Joint / Q000601:surgery*; D013710:Tendons / Q000637:transplantation*; D016896:Treatment Outcome
Anterior sternoclavicular instability; Clinical outcome; Complications; Graft reconstruction; Systematic review