Journal: Arthroscopy Techniques
Article Title: Chronic Instability and Pain of the Sternoclavicular Joint: Treatment With Semitendinosus Allograft to Restore Joint Stability
doi: 10.1016/j.eats.2019.02.006
Figure Lengend Snippet: The patient is positioned in a reclined beach chair position, and an incision is made extending from the medial aspect of the right-hand clavicle to the contralateral sternoclavicular (SC) joint. Two self-retaining retractors are placed on the medial and lateral edges of the incision, and the capsule of the SC joint is dissected down with a needle tip bovie. The clavicle is mobilized anteriorly and superiorly with a small Hohman retractor placed on the posterior border and a bone hook on the medial aspect of the clavicle. An oscillating saw is used to debulk the medial clavicular cortices of osteophytes. The clavicle is further contoured with a rongeur to minimize subcutaneous prominence. The site of the lateral bone tunnel is identified 25 mm from the medial edge of the SC joint. A guide pin is introduced onto the anterior surface of the clavicle and is overdrilled with a cannulated 6-mm drill into the intramedullary canal. The guide pin is then advanced 25 mm laterally through the intramedullary canal and is then overdrilled with a 6-mm drill. Using a similar technique as on the clavicle, 2 parallel 6-mm bone tunnels are created on the sternum with each tunnel converging deep within the sternum. Two looped-sutures are then shuttled through the intramedullary canal of the sternum exiting each tunnel limb. The sutures are shuttled such that the looped ends exit into the SC joint. A semitendinosus allograft is prepared with locking sutures of no. 5 FiberWire and FiberTape grasping each end. The graft is passed circumferentially around the clavicle, and the 2 limbs of the graft are advanced into the anterior bone tunnel using the looped sutures, finally pulled medially through the intramedullary canal. The graft is then tightened to lock around the clavicle, and using the 2 looped suture ends, each limb of the graft is advanced through the sternal bone tunnels. The clavicle is then manually reduced to its anatomic position at the site of the SC joint. While holding tension on the graft limbs, 2 biocomposite interference screws are advanced into each sternal bone tunnel to secure the graft. The excess graft limbs are then crossed and advanced laterally over the SC joint to serve as a capsular reconstruction. The graft is oversewn to itself using a nonabsorbable suture tape in a locking fashion. The stability of the construct is tested manually to identify any residual laxity of the sternoclavicular joint.
Article Snippet: While holding tension on the graft limbs, 2 biocomposite interference screws (PEEK Bio-Tenodesis; Arthrex, Naples, FL) are advanced into each sternal bone tunnel to secure the graft ( ).
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