Midterm results of chronic anterior instability of the sternoclavicular joint managed using a standardized treatment algorithm
Athanatos, Lambros Tunnicliffe, Helen Singh, Harvinder Armstrong, Alison
Athanatos, Lambros
Tunnicliffe, Helen
Singh, Harvinder
Armstrong, Alison
Abstract
Aims: There remains a lack of consensus regarding the management of chronic anterior sternoclavicular joint (SCJ) instability. This study aimed to assess whether a standardized treatment algorithm (incorporating physiotherapy and surgery and based on the presence of trauma) could successfully guide management and reduce the number needing surgery.
Methods: Patients with chronic anterior SCJ instability managed between April 2007 and April 2019 with a standardized treatment algorithm were divided into non-traumatic (offered physiotherapy) and traumatic (offered surgery) groups and evaluated at discharge. Subsequently, midterm outcomes were assessed via a postal questionnaire with a subjective SCJ stability score, Oxford Shoulder Instability Score (OSIS, adapted for the SCJ), and pain visual analogue scale (VAS), with analysis on an intention-to-treat basis.
Results: A total of 47 patients (50 SCJs, three bilateral) responded for 75% return rate. Of these, 31 SCJs were treated with physiotherapy and 19 with surgery. Overall, 96% (48/50) achieved a stable SCJ, with 60% (30/50) achieving unrestricted function. In terms of outcomes, 82% (41/50) recorded good-to-excellent OSIS scores (84% (26/31) physiotherapy, 79% (15/19) surgery), and 76% (38/50) reported low pain VAS scores at final follow-up. Complications of the total surgical cohort included a 19% (5/27) revision rate, 11% (3/27) frozen shoulder, and 4% (1/27) scar sensitivity.
Conclusion: This is the largest midterm series reporting chronic anterior SCJ instability outcomes when managed according to a standardized treatment algorithm that emphasizes the importance of appropriate patient selection for either physiotherapy or surgery, based on a history of trauma. All but two patients achieved a stable SCJ, with stability maintained at a median of 70 months (11 to 116) for the physiotherapy group and 87 months (6 to 144) for the surgery group.Cite this article: Bone Jt Open 2022;3(10):815-825.
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Date
2022-10-20
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Athanatos, L., Kulkarni, K., Tunnicliffe, H., Samaras, M., Singh, H. P., & Armstrong, A. L. (2022). Midterm results of chronic anterior instability of the sternoclavicular joint managed using a standardized treatment algorithm. Bone & joint open, 3(10), 815–825. https://doi.org/10.1302/2633-1462.310.BJO-2022-0088