Clinical Outcomes and Complications After Sternoclavicular Joint Reconstruction for Chronic Instability: A Systematic Review

Abstract

Background:

Chronic sternoclavicular (SC) joint instability is a relatively rare orthopaedic pathology that is treated with surgical reconstruction when symptoms persist despite adequate nonsurgical treatment. There are a variety of surgical techniques; however, the literature on the topic is limited to small case series.

Purpose:

To provide a comprehensive systematic review of the surgical variables, clinical outcomes, and complications after SC joint reconstruction.

Study Design:

Systematic review; Level of evidence, 4.

Methods:

A systematic review of the literature was conducted following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. PubMed and MEDLINE were searched using a comprehensive search strategy for articles involving SC joint reconstructions. A descriptive and critical analysis of the results was performed.

Results:

Twelve studies comprising 164 patients (169 SC joint reconstructions) were identified. Bicortical reconstruction was the most frequently used technique overall (63% of cases) and was used more often in the setting of posterior instability (87%). All studies demonstrated significant improvements in patient-reported outcome measures (PROMs) regardless of graft type, technique, or direction of instability. Complication rates were similar between techniques (9% bicortical vs 15% unicortical; P = .23), although there was a trend toward a higher rate of recurrent instability when utilizing unicortical reconstruction techniques (3% bicortical vs 10% unicortical; P = .06). Allograft and autograft reconstructions also had a similar overall complication (12% autograft vs 10% allograft; P = .68) and revision rates (4% autograft vs 4% allograft; P = .83). All techniques allowed a high rate of return to sport or work (83%), although limitations were noted in some cases (35%).

Conclusion:

This review found that SC joint reconstruction leads to significant improvements in PROMs and return to activity, with a low complication rate, regardless of technique type, including unicortical versus bicortical and allograft versus autograft reconstruction. This study supports the need for further comparative and biomechanical studies to validate findings and refine surgical recommendations.