Surgical management of chronic sternoclavicular joint instability

Instability of the sternoclavicular (SC) joint is a rare entity and usually the result of high impact trauma. The chronic anterior instability caused by insufficient posttraumatic ligament healing, is manifested as frequently recurring subluxation of the medial end of the clavicle, which not uncommonly leads to pain, especially during overhead activities. In contrast, in cases of posterior instability vegetative symptoms (e.g. dyspnea) sometimes occur due to compression of the retrosternal vessels and/or the trachea, which are in the close proximity. The literature on the treatment of chronic SC joint instability is limited; nevertheless, the available outcome data show a superiority of surgical procedures over conservative treatment. Over the years various techniques for treatment with plates, anchors and grafts have been described. The stabilization technique in a figure of eight configuration with the use of a tendon graft has become widely established as a standard procedure in many shoulder centers due to reliable functional results. The following article provides an overview of current treatment concepts for chronic instability of the SC joint.