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Discus preserving reconstruction of recurrent anterior sterno-clavicular instability in young persons: a 1-5 years follow-up.
ESSKA Academy. Rathcke M. May 11, 2018; 218035; FP22-1971
Mr. Martin Rathcke
Mr. Martin Rathcke
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Abstract
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Objectives: Recurrent anterior luxation of the sternoclavicular joint (SCJ) is a functionally disabling condition, which complicate overhead activities and many sports. It occurs in young persons, often nontraumatic or after a minor trauma. If non-operative treatment (physiotherapy) fails, surgical treatment is indicated. Often the discus is resected, but in young persons it should preferedly be saved, and therefore we introduce a stabilizing procedure that is preserving the discus. It uses a gracilis autograft to form a triangular reconstruction of the anterior SCJ capsule, anchoring the graft to manubrium and the medial clavicle.

Objectives
To present the 1-5 year-result of this discus preserving SCJ reconstruction for recurrent anterior dislocation in a prospective cohort.

Methods: 30 SCJs (16 right /14 Left) in 25 patients (5 had bilateral instability) were operated for recurrent dislocation of the SCJ during the period 2010-17. Two patients had a re-operation due to recurrence of the SCJ instability. Allografts were used in two patients, one primary and one re-operation.
All patients filled in the DASH questionnaire, OSS and WOSI *) before the operation and at 1, 2 and 5-year follow-up. Stability, pain and satisfaction were also registered.
*) Disability of Arm, Shoulder and Hand Score, Oxford Shoulder Score and Western Ontario Shoulder Instability Index.

Results: Mean age at operation was 19 years (13-30). In 5 patients, the procedure was bilateral.
At 1-year follow-up there was 4 re-instabilities, and two of these were re-operated. 26 SCJ = 87 % were considered stable. One patient had suture of a torn disc. Two patients complained of donor site from harvest of the gracilis tendon, and 3 patients had keloid formation in their scar. The subjective condition evaluated with DASH was significantly increased at follow-up.

Conclusions: The 1 - 5 year results of a new discus preserving SCJ-reconstruction using a gracilis graft had a satisfying outcome, as 87 % were stable at follow-up. We suggest a discus- and joint-preserving procedure for anterior SCJ reconstruction is standard in young patients with intact discus and cartilage.

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