Figure-of-Eight Tendon Graft Reconstruction for Sternoclavicular Joint Instability: Biomechanical Rationale, Surgical Technique, and a Review of Clinical Outcomes

• Published in: Operative techniques in sports medicine 2014-09, Vol.22 (3), p.260-268
• Main Authors: Warth, Ryan J., MD, Lee, Jared T., MD, Millett, Peter J., MD, MSc
• Format: Article
• Language: English
• Subjects: autograft; Clinical outcomes; figure of eight; Joint surgery; Knee; Ligaments; Orthopedics; outcomes; reconstruction; Rheumatology; Skin & tissue grafts; sternoclavicular; technique; Tendons
• ISSN: 1060-1872; 1557-9794
• DOI: 10.1053/j.otsm.2013.10.011

Sternoclavicular (SC) joint injuries are rare and result in disruption of the capsular and costoclavicular ligaments. Sprains and subluxations in general can be effectively treated with nonoperative modalities. Posterior instability and symptomatic anterior instability require operative stabilization of the SC joint. Several surgical techniques have been described to stabilize the SC joint; however, figure-of-eight reconstruction with free tendon graft has been shown to recreate the native anatomy with the most robust biomechanical profile. We describe a technique for SC joint reconstruction using a gracilis tendon autograft in a figure-of-eight configuration. A thorough understanding of SC joint anatomy is required to prevent inadvertent injury to the closely associated mediastinal vessels. At our institution, 5 patients (6 shoulders) demonstrated measurable improvements in American Shoulder and Elbow Surgeons, Quick Disabilities of the Arm, Shoulder, and Hand, and Single Assessment Numeric Evaluation scores over baseline without recurrent instability after a minimum 1-year follow-up period. We have found that this technique most reliably recreates the native anatomy and biomechanics while also minimizing the potential for complications.