CASE REPORT


Sternoclavicular Joint Reconstruction with Semitendinosus Allograft and Suture Anchors after Recurrent Posterior Dislocation in a Professional North American Football Player



Yung Han1, Elizabeth H. Cho1, *, Adriana Martinez2, Paul A. Martineau2
1 Los Angeles Shoulder Institute, Los Angeles, CA 90020, USA
2 Department of Orthopedic Surgery, McGill University, Montreal, Quebec, Canada


Article Metrics

CrossRef Citations:
0
Total Statistics:

Full-Text HTML Views: 266
Abstract HTML Views: 125
PDF Downloads: 117
ePub Downloads: 460
Total Views/Downloads: 968
Unique Statistics:

Full-Text HTML Views: 178
Abstract HTML Views: 88
PDF Downloads: 95
ePub Downloads: 296
Total Views/Downloads: 657



Creative Commons License
© 2022 Han et al.

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: https://creativecommons.org/licenses/by/4.0/legalcode. This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

* Address correspondence to this author at the Los Angeles Shoulder Institute, 505 S. Virgil Ave. Ste. 205, Los Angeles, CA 90020, USA; Tel: 213-805-5822; E-mail: elicho28@gmail.com.


Abstract

Background:

Posterior sternoclavicular joint dislocations are an extremely rare but potentially life-threatening injury that can occur in sports. A variety of surgical procedures have been proposed, but there is no consensus on the treatment of choice. It is also largely unknown if a safe return to high-risk sports is possible.

Case Presentation:

We present a case of a posterior sternoclavicular joint dislocation in a 22-year-old male professional North American football player who had a recurrent irreducible posterior dislocation after initial injury management by closed reduction. The patient’s desire to return to football presented unique challenges to management. His sternoclavicular joint was subsequently reconstructed with semitendinosus allograft in a figure-of-eight augmented with suture anchors. After recovery, he returned to play as a running back in professional football symptom-free.

Conclusion:

Our patient's successful return to playing professional football after the sternoclavicular joint reconstruction suggests that this should be considered an effective treatment option when managing posterior sternoclavicular dislocation in high level contact sports players.

Keywords: Posterior sternoclavicular dislocation, Sternoclavicular instability, Sternoclavicular reconstruction, Football, Sports injury, Recurrent sternoclavicular dislocation.



1. INTRODUCTION

Sternoclavicular (SC) joint dislocations are an extremely rare injury accounting for less than 1% of all traumatic joint dislocations [1]. Anterior SC joint dislocations are 20% more common [2] and rarely problematic, whereas posterior SC joint dislocations are associated with a high incidence of morbidity and mortality due to the joint's close proximity with mediastinal structures. Posterior SC joint dislocations are a medical emergency requiring prompt reduction, however, controversy exists in management. Attempts at closed reduction have a high incidence of failure [3-5], and open reduction and surgical stabilization is indicated for irreducible or recurrent cases [6-8]. A variety of techniques have been proposed, but there is no consensus on the treatment of choice.

Sports injuries are the second most common cause of posterior SC joint dislocation [9, 10]. North American football poses a high risk for posterior SC joint dislocation because of the protracted position of the arm and the frequent, high impact collisions to the chest and shoulder [1]. Due to this increased risk in football players and the morbidity and mortality associated with this injury, there should be an increased concern for stability to resume such high risk contact activities. Most previous reports in the literature have focused mainly on the diagnosis and management, while neglecting to mention if a safe return to high risk contact sports was possible.

We present a case of a posterior SC joint dislocation in a professional North American football player who had a recurrent irreducible posterior dislocation after initial injury management by closed reduction. The patient’s desire to return to professional football presented unique challenges to management. His SC joint was subsequently reconstructed with semitendinosus allograft and suture anchors, and he successfully returned to play professional football. To our knowledge, this is the first reported case of this entity in a professional North American football player.

2. CASE REPORT

A 22-year-old running back for a professional North American football team was transferred to our trauma center by his team physician after being tackled during a game in July 2007. He complained of severe right upper thoracic pain. Physical examination was significant for swelling and tenderness over the right medial clavicle. Chest and clavicle x-rays were unremarkable, but the CT scan showed complete dislocation of the right SC joint with the medial clavicle mildly encroaching on the right subclavian vein (Fig. 1). Patient was brought urgently to the operating room for closed reduction of the SC joint under general anesthesia by cardiothoracic and orthopaedic surgery. He was placed in a supine position with a sandbag between the scapulae. In line traction was applied to the arm at 90 degrees of abduction, and a towel clip was used to gain control of the clavicle and guide reduction. A click was heard, and the intraoperative fluoroscopic Serendipity view confirmed reduction. Postoperatively, the patient was placed in a figure-of-eight bandage. At 4 weeks, he was not tender to palpation, had a full range of shoulder motion, and the SC joint was stable under posterior load. He started rehabilitation and was cleared to play football by team physicians at 10 weeks.

Fig. (1). CT scan showing right posterior SC joint dislocation with the medial end of the clavicle mildly encroaching on the subclavian vein.

On his first game back, he complained of the same pain after a tackle. He was assessed, diagnosed, and stabilized at the field by the team physician and once again transferred to our trauma center. This time, he also complained of shortness of breath, but his oxygen saturation was 100% on room air. CT scan confirmed a recurrent posterior dislocation of his SC joint (Fig. 2).

Fig. (2). CT scan showing recurrence of posterior SC joint dislocation.

He was taken to the operating room for an attempt at a closed reduction with possible open reduction and SC joint reconstruction. A cardiothoracic surgeon was present in the operating room, and the patient’s arm and chest were sterilely prepped for the potential requirement of a sternotomy to address possible intrathoracic vascular compromise. The closed reduction did not maintain a stable joint, and therefore an open reduction was performed. A skin incision was made transversely over the clavicle and then curved longitudinally over the sternum in line with a potential sternotomy incision. Dissection was carried through subcutaneous tissue, platysma, and the trapezial and pectoral attachments to expose the medial end of the clavicle. The manubrium was dissected free from soft tissue to allow 1 finger behind the sternal notch. A 4.5mm hole was drilled into both the manubrium and clavicle from an anteroinferior to the posterosuperior direction (Fig. 3C-D) to minimize iatrogenic injury. This was drilled incrementally with a 2.0mm, 2.5mm, 3.5mm, and 4.5mm drill to minimize the force needed to drill and avoid plunging. A semitendinosus allograft was then cut to a 4.5mm diameter and passed through the drill holes in a figure-of-eight fashion similar to the method described by Castropil et al. [11] used to reconstruct an anteriorly dislocated SC joint in a Judo player. In addition, TwinFix FT suture anchors (Smith & Nephew, London, United Kingdom) were placed in the manubrium and clavicle to augment the reconstruction (Fig. 3A-E). Closure involved repairing the capsule and reattaching the pectoral and trapezial attachments. Postoperatively, he was immobilized for 6 weeks and then progressed with range of motion and strengthening exercises. He was counseled not to return to collision sports due to the potentially life threatening nature of his injury and the paucity of outcomes in this patient population in the literature. The patient requested a second opinion and was referred to another orthopaedic surgeon also experienced in the care of professional athletes, who then referred the patient to yet another colleague due to a lack of personal experience with this injury. After the patient’s SC joint was manually tested with approximately 90kg of posteriorly directed force, he was cleared to play football and subsequently returned to play professional football successfully the next season. He played 2 more seasons with no recurrence of pain or instability at this high-impact position before retiring for reasons unrelated to health or football.

Fig. (3). Post-operative CT scan showing reconstruction of the SC joint with drill holes for the figure-of-eight semitendinosus allograft and 2 suture anchors in axial (A-B), sagittal (C-D), and coronal views (E).

3. DISCUSSION

Posterior SC joint dislocations are an extremely rare but serious injury representing only 0.03-0.05% of all traumatic joint dislocations [1, 2]. A third of the cases have had associated complications such as vascular compromise, pneumothorax, myocardial conduction abnormalities, brachial plexus compression, tracheal impingement, esophageal rupture, and fatal tracheoesophageal fistula [3, 9, 12-19]. A prompt diagnosis and reduction can reduce complications and improve the chances of a successful outcome [3, 4].

A high index of suspicion is needed to diagnose this injury. Motor vehicle collisions (40-47%), sports (21-31%), and falls are the most common causes of SC joint dislocations [9, 20]. Mechanism of injury can be by direct trauma to the SC joint or by indirect trauma to the shoulder, causing an axial load to the clavicle. If the acromion is posterior to the sternum (which is more often the case), then an anterior dislocation can occur and conversely, if the acromion is anterior to the sternum (such as in football tackling positions), then a posterior dislocation can occur [13, 21-23]. Clinical findings alone cannot always distinguish between anterior and posterior dislocations, and diagnosis is ultimately made by imaging [24]. Adequate x-rays are challenging because of superimposed structures and special views such as Hobbs, Heinig, or the Serendipity view attempt to overcome this challenge [7, 25-27]. Nonetheless, CT scan remains the gold standard to make the diagnosis and can also give information on vital adjacent structures and help differentiate a physeal fracture from a true dislocation for patients under the age of 25 [21, 28, 29].

Urgent reduction is necessary despite a lack of symptoms, and delays in reduction are associated with complications and failure to achieve reduction [6, 16, 30, 31]. There is controversy over whether to proceed with a closed or open reduction. Wirth notes in his review of the literature that the standard treatment has been an open reduction, however, since the 1950’s, the preference has been attempting a closed reduction first [20, 32, 33]. It has been argued as an excellent first line treatment because it is effective and conservative. However, while attempts at closed reduction are generally safe, it has a low success rate (50%) [3, 4, 29] and is not completely free of complications. Worman and Leagus had reported a posterior SC joint dislocation that was found during open reduction to have the clavicle impale the right pulmonary artery [16]. They noted had a closed reduction been attempted in the ED, the result could have been disastrous. In patients under the age of 25, a physeal fracture should be on the differential. CT scan fails to recognize this in half the cases [4]. Some authors point to the excellent osteogenic healing potential and bony remodeling as reasons for managing these injuries with a closed reduction [20, 23], however, Laffosse et al. cite 100% failure in attempts at closed reduction due to entrapped periosteum and advocate an open approach [4]. Open reduction and surgical stabilization is indicated when closed reduction fails or in recurrent instability. A variety of surgical procedures have been described including Steinmann pin fixation [20], Kirschner wire fixation (simple [34] and tension banding [35]), screw fixation [36], plate fixation with a variety of techniques (Ledge plating [37], Balser plate [38, 39], and locking plate [40-42]), external fixation [43], suturing with a variety of materials and techniques (synthetic [44, 45], transosseous sutures [46-49], and suture anchors [50]), reconstruction with different soft-tissue grafts (sternocleidomastoid [51-53], fascia lata [40], semitendinosus [52, 54, 55], subclavius [56], palmaris longus [57], and iliotibial band [57]), and medial clavicle resection with and without interpositional arthroplasty [52, 58]. Because of the rarity of surgical cases, prospective comparative studies do not exist and thus no treatment of choice has been established. The evidence that we have to direct our decision making is in previous case studies, biomechanical studies, and expert opinion.

The SC joint has the least amount of bony stability of all the major joints in the body, and its stability is predominantly based on its strong ligamentous attachments [20, 59-61]. Cadaveric sectioning experiments have shown that the posterior capsular ligaments are stronger than the anterior ligaments [62], and it has been cited that this is the reason why posterior dislocations are less common than anterior dislocations [59, 63]. However, clinically, in complete dislocations, both ligaments are likely torn, and the direction of force is more likely the determining factor. The SC joint is a diarthrodial joint, but behaves more like a ball and socket joint allowing movement in all planes, including rotation [2]. It is the only true articulation between the upper extremity and the axial skeleton and, therefore, is likely the most frequently moved joint in the body [58, 64]. Considerations in surgical stabilization should try to respect this anatomy. Therefore, hardware or rigid fixation across or through the joint is less than ideal. The risk of implant failure exists, and migration of pins with grave morbidity, including 7 deaths, has been reported [34, 65-73]. Early arthritis has been reported postoperatively [38]. Methods to stabilize the SC joint while preserving motion are preferred. The biomechanical study by Spencer and Kuhn has shown that figure-of-eight with a semitendinosus graft had the highest load to failure and stiffness when compared to two other techniques – intramedullary tendon and subclavius reconstructions [62]. Since this finding, more studies utilized the figure-of-eight graft reconstruction in treating sternoclavicular instability [29, 54, 55, 74-79].

In our patient, the surgeon (P.A.M.) reconstructed the sternoclavicular joint using a figure-of-eight with a semitendinosus allograft similar to the method described by Castropil [11], who successfully treated a chronically anterior dislocated SC joint in a high-level Judo player. The primary difference between this method and that in Spencer’s biomechanical study [62] is the use of one drill hole in the clavicle and sternum compared to two. While the technique using two drill holes is theoretically stronger, there is an increased risk of fracture ((Fig. 3) shows little space available to safely accommodate two 4.5mm drill holes) and iatrogenic injury compared to one drill hole. The reconstruction, in this case, was also augmented with suture anchors which have been reported to repair dislocated SC joint as the sole treatment [50], and the capsule was also repaired.

Posterior SC joint dislocation is seen particularly in association with American football [1], however, there is little information on outcomes and no definitive guidelines for return to high risk, contact sports. Laffosse et al. [4] published (after the time of injury of our patient) a relatively large case series (26 patients) of posterior SC joint dislocations in young workers and sports players with good to excellent results treated with closed or open reduction with a primary repair or a variety of surgical stabilization techniques. Eighteen of the 26 patients were able to resume their usual sports activities at the same level. All patients had a primary occupation other than their sport, so it appears that they were all recreational athletes. A more recent study of 18 patients, including recreational and professional sports players, showed high rates of survivorship (90%) and return-to-sports (94%) at a minimum 5-year follow-up of the surgical figure-of-eight reconstruction technique using hamstring autograft [80]. Although the study population consisted of those with preoperative SC joint instability resulting from anterior dislocation, the applied construct’s stability and potential in enabling a preinjury level of sports activity should be noted, especially in the dearth of studies monitoring postoperative return to sports after SC joint reconstruction.

Because of our patient’s occupation, that of a running back in professional North American football, his demands and the amount of stress that his SC joint will be subjected to are quite different than the average person. Moreover, we suspect the forces across the SC joint in a professional running back are much greater than the average weekend warrior or limited contact sports athlete. To our knowledge, there have been two cases of posterior SC joint dislocation reported in similar level athletes since the injury of our patient. A division I collegiate cornerback [81] and a professional league wide receiver [82] each underwent successful closed reductions, and the latter returned to football asymptomatically after 5 weeks. However, our patient had redislocated on his first game back after his initial treatment by closed reduction. Fortunately, there were no associated mediastinal injuries. In proceeding with open reduction and surgical stabilization, we found only one case report that was similar. Brinker [36] reported open reduction and rigid internal fixation with two 7.0mm cannulated screws to treat a posteriorly dislocated SC joint in a collegiate football player. The screws were removed 3 months postoperatively and screw holes were grafted with allograft bone. The patient returned to collegiate football approximately a year later. The advantages of our surgical method in reconstructing the SC joint with a soft tissue graft are that it involves only one surgical procedure, does not violate the joint with hardware, and motion is preserved. The literature supports the use of semitendinosus in a figure-of-eight as the strongest soft tissue construct.

CONCLUSION

Our patient returned to professional football as a running back and was symptom free from his SC joint reconstruction. We believe that this is an option that should be highly considered when managing a posterior dislocation in a high-level contact player. However, based on the paucity of literature and evidence on the topic, we still feel that players should be seriously counseled about the potential dangers associated with this injury and the unknown risk of recurrence. Therefore, discontinuation of participation in contact sports after this type of injury, even despite a clinically successful reconstruction, remains our ideal recommendation.

LIST OF ABBREVIATION

SC = Sternoclavicular

ETHICS APPROVAL AND CONSENT TO PARTICIPATE

This study has been approved by the Research Ethics Board of McGill University Health Centre in Canada with the approval number 12-300 GEN.

HUMAN AND ANIMAL RIGHTS

No animals were involved for studies that are the basis of this research. All the humans used were in accordance with the Research Ethics Board of McGill University Health Centre in Canada and with the Helsinki Declaration of 1975 as revised in 2013.

CONSENT FOR PUBLICATION

Not applicable.

STANDARDS OF REPORTING

CARE guidelines were followed.

AVAILABILITY OF DATA AND MATERIALS

Not applicable.

FUNDING

None.

CONFLICT OF INTEREST

Yung Han is on the Editorial Advisory Board of The Open Orthopaedics Journal.

ACKNOWLEDGEMENTS

Declared none.

REFERENCES

[1] Marker LB, Klareskov B. Posterior sternoclavicular dislocation: an American football injury. Br J Sports Med 1996; 30(1): 71-2.
[2] Rockwood CA Jr. Disorders of the sternoclavicular joint.The shoulder 1990; 477-525.
[3] Groh GI, Wirth MA, Rockwood CA Jr. Treatment of traumatic posterior sternoclavicular dislocations. J Shoulder Elbow Surg 2011; 20(1): 107-13.
[4] Laffosse JM, Espié A, Bonnevialle N, et al. Posterior dislocation of the sternoclavicular joint and epiphyseal disruption of the medial clavicle with posterior displacement in sports participants. J Bone Joint Surg Br 2010; 92-B(1): 103-9.
[5] Lee JT, Nasreddine AY, Black EM, Bae DS, Kocher MS. Posterior sternoclavicular joint injuries in skeletally immature patients. J Pediatr Orthop 2014; 34(4): 369-75.
[6] Glass ER, Thompson JD, Cole PA, Gause TM II, Altman GT. Treatment of sternoclavicular joint dislocations: a systematic review of 251 dislocations in 24 case series. J Trauma 2011; 70(5): 1294-8.
[7] Groh GI, Wirth MA. Management of traumatic sternoclavicular joint injuries. J Am Acad Orthop Surg 2011; 19(1): 1-7.
[8] Thut D, Hergan D, Dukas A, Day M, Sherman OH. Sternoclavicular joint reconstruction--a systematic review. Bull NYU Hosp Jt Dis 2011; 69(2): 128-35.
[9] Rockwood CA Jr, Wirth MA. Injuries to the sternoclavicular joint.Fracture in adults 5th ed. 2001; 1245-92.
[10] Waters PM, Bae DS, Kadiyala RK. Short-term outcomes after surgical treatment of traumatic posterior sternoclavicular fracture-dislocations in children and adolescents. J Pediatr Orthop 2003; 23(4): 464-9.
[11] Castropil W, Ramadan LB, Bitar AC, Schor B, de Oliveira D’Elia C. Sternoclavicular dislocation—reconstruction with semitendinosus tendon autograft: a case report. Knee Surg Sports Traumatol Arthrosc 2008; 16(9): 865-8.
[12] Jougon JB, Lepront DJ, Dromer CEH. Posterior dislocation of the sternoclavicular joint leading to mediastinal compression. Ann Thorac Surg 1996; 61(2): 711-3.
[13] Martin SD, Altchek D, Erlanger S. Atraumatic posterior dislocation of the sternoclavicular joint. A case report and literature review. Clin Orthop Relat Res 1993; 292(292): 159-64.
[14] Mehta JC, Sachdev A, Collins JJ. Retrosternal dislocation of the clavicle. Injury 1973; 5(1): 79-83.
[15] Ono K, Inagawa H, Kiyota K, Terada T, Suzuki S, Maekawa K. Posterior dislocation of the sternoclavicular joint with obstruction of the innominate vein: case report. J Trauma Inj Infect Crit Care 1998; 44(2): 381-3.
[16] Worman LW, Leagus C. Intrathoracic injury following retrosternal dislocation of the clavicle. J Trauma 1967; 7(3): 416-23.
[17] Bakir MS, Merschin D, Unterkofler J, et al. Injuries of the Medial Clavicle: A Cohort Analysis in a Level-I-Trauma-Center. Concomitant Injuries. Management. Classification. Chirurgia (Bucur) 2017; 112(5): 594.
[18] Kim YH, Kim JJ, Choi SY, Jeong SC, Kim IS. Successful repair of thoracic outlet syndrome in a growing young patient due to posterior sternoclavicular joint dislocation. J Thorac Dis 2017; 9(10): E912-5.
[19] Calderazzi F, Menozzi M, Valenti P, et al. A rare case of complicated pure posterior sternoclavicular dislocation in a young athlete. Acta Biomed 2020; 91(14-S)(Suppl. 14): e2020015.
[20] Wirth MA, Rockwood CA Jr. Acute and Chronic Traumatic Injuries of the Sternoclavicular Joint. J Am Acad Orthop Surg 1996; 4(5): 268-78.
[21] Buckley BJ, Hayden SR. Posterior sternoclavicular dislocation. J Emerg Med 2008; 34(3): 331-2.
[22] Gove N, Ebraheim NA, Glass E. Posterior sternoclavicular dislocations: a review of management and complications. Am J Orthop 2006; 35(3): 132-6.
[23] Jaggard MKJ, Gupte CM, Gulati V, Reilly P. A comprehensive review of trauma and disruption to the sternoclavicular joint with the proposal of a new classification system. J Trauma 2009; 66(2): 576-84.
[24] Gottschalk HP, Browne RH, Starr AJ. Shoulder girdle: patterns of trauma and associated injuries. J Orthop Trauma 2011; 25(5): 266-71.
[25] Gobet R, Meuli M, Altermatt S, Jenni V, Willi UV. Medial clavicular epiphysiolysis in children: the so-called sterno-clavicular dislocation. Emerg Radiol 2004; 10(5): 252-5.
[26] Salgado R, Ghysen D. Post-traumatic posterior sternoclavicular dislocation: case report and review of the literature. Emerg Radiol 2002; 9(6): 323-5.
[27] Thomas DP, Davies A, Hoddinott HC. Posterior sternoclavicular dislocations--a diagnosis easily missed. Ann R Coll Surg Engl 1999; 81(3): 201-4.
[28] Sullivan JP, Warme BA, Wolf BR. Use of an O-arm intraoperative computed tomography scanner for closed reduction of posterior sternoclavicular dislocations. J Shoulder Elbow Surg 2012; 21(3): e17-20.
[29] Garcia JA, Arguello AM, Momaya AM, Ponce BA. Sternoclavicular joint instability: symptoms, diagnosis and management. Orthop Res Rev 2020; 12: 75-87.
[30] Eskola A. Sternoclavicular dislocation: A plea for open treatment. Acta Orthop Scand 1986; 57(3): 227-8.
[31] Ferrandez L, Yubero J, Usabiaga J, No L, Martin F. Sternoclavicular dislocation. Treatment and complications. Ital J Orthop Traumatol 1988; 14(3): 349-55.
[32] Morell DJ, Thyagarajan DS. Sternoclavicular joint dislocation and its management: A review of the literature. World J Orthop 2016; 7(4): 244-50.
[33] Sernandez H, Riehl J. Sternoclavicular Joint Dislocation: A Systematic Review and Meta-analysis. J Orthop Trauma 2019; 33(7): e251-5.
[34] Lyons FA, Rockwood CA Jr. Migration of pins used in operations on the shoulder. J Bone Joint Surg Am 1990; 72(8): 1262-7.
[35] Chen QY, Cheng SW, Wang W, et al. K-wire and tension band wire fixation in treating sternoclavicular joint dislocation. Chin J Traumatol 2011; 14(1): 53-7.
[36] Brinker MR, Bartz RL, Reardon PR, Reardon MJ. A method for open reduction and internal fixation of the unstable posterior sternoclavicular joint dislocation. J Orthop Trauma 1997; 11(5): 378-81.
[37] Hecox SE, Wood GW II. Ledge plating technique for unstable posterior sternoclavicular dislocation. J Orthop Trauma 2010; 24(4): 255-7.
[38] Franck WM, Jannasch O, Siassi M, Hennig FF. Balser plate stabilization: an alternate therapy for traumatic sternoclavicular instability. J Shoulder Elbow Surg 2003; 12(3): 276-81.
[39] Feng W, Cai X, Li S, et al. Balser plate stabilization for traumatic sternoclavicular instabilities or medical clavicle fractures: a case series and literature review. Orthop Surg 2020; 12(6): 1627-34.
[40] Shuler FD, Pappas N. Treatment of posterior sternoclavicular dislocation with locking plate osteosynthesis. Orthopedics 2008; 31(3): 273.
[41] Quispe JC, Herbert B, Chadayammuri VP, et al. Transarticular plating for acute posterior sternoclavicular joint dislocations: a valid treatment option? Int Orthop 2016; 40(7): 1503-8.
[42] Ao R, Zhu Y, Zhou J, et al. Locking plate for treating traumatic sternoclavicular joint dislocation: a case series. BMC Musculoskelet Disord 2018; 19(1): 7.
[43] Cooper GJ, Stubbs D, Waller DA, Wilkinson GAL, Saleh M. Posterior sternoclavicular dislocation: a novel method of external fixation. Injury 1992; 23(8): 565-6.
[44] Reilly P, Bruguera JA, Copeland SA. Erosion and nonunion of the first rib after sternoclavicular reconstruction with Dacron. J Shoulder Elbow Surg 1999; 8(1): 76-8.
[45] Quayle JM, Arnander MWT, Pennington RG, Rosell LP. Artificial ligament reconstruction of sternoclavicular joint instability: report of a novel surgical technique with early results. Tech Hand Up Extrem Surg 2014; 18(1): 31-5.
[46] Baumann M, Vogel T, Weise K, Muratore T, Trobisch P. Bilateral posterior sternoclavicular dislocation. Orthopedics 2010; 33(7): 01477447-20100526-19.
[47] Mirza AH, Alam K, Ali A. Posterior sternoclavicular dislocation in a rugby player as a cause of silent vascular compromise: a case report. Br J Sports Med 2005; 39(5): e28.
[48] Rotini R, Guerra E, Bettelli G, Marinelli A, Frisoni T. Sterno clavicular joint dislocation: a case report of a surgical stabilization technique. Musculoskelet Surg 2010; 94(S1)(Suppl. 1): 91-4.
[49] Adamcik S, Ahler M, Gioutsos K, Schmid RA, Kocher GJ. Repair of sternoclavicular joint dislocations with FiberWire®. Arch Orthop Trauma Surg 2017; 137(3): 341-5.
[50] Abiddin Z, Sinopidis C, Grocock CJ, Yin Q, Frostick SP. Suture anchors for treatment of sternoclavicular joint instability. J Shoulder Elbow Surg 2006; 15(3): 315-8.
[51] Armstrong AL, Dias JJ. Reconstruction for instability of the sternoclavicular joint using the tendon of the sternocleidomastoid muscle. J Bone Joint Surg Br 2008; 90-B(5): 610-3.
[52] Bae DS, Kocher MS, Waters PM, Micheli LM, Griffey M, Dichtel L. Chronic recurrent anterior sternoclavicular joint instability: results of surgical management. J Pediatr Orthop 2006; 26(1): 71-4.
[53] Uri O, Barmpagiannis K, Higgs D, Falworth M, Alexander S, Lambert SM. Clinical outcome after reconstruction for sternoclavicular joint instability using a sternocleidomastoid tendon graft. J Bone Joint Surg Am 2014; 96(5): 417-22.
[54] Singer G, Ferlic P, Kraus T, Eberl R. Reconstruction of the sternoclavicular joint in active patients with the figure-of-eight technique using hamstrings. J Shoulder Elbow Surg 2013; 22(1): 64-9.
[55] Peebles LA, Aman ZS, Preuss FR, et al. Chronic Instability and Pain of the Sternoclavicular Joint: Treatment With Semitendinosus Allograft to Restore Joint Stability. Arthrosc Tech 2019; 8(6): e629-35.
[56] Barth E, Hagen R. Surgical treatment of dislocations of the sternoclavicular joint. Acta Orthop Scand 1983; 54(5): 746-7.
[57] Noda M, Shiraishi H, Mizuno K. Chronic posterior sternoclavicular dislocation causing compression of a subclavian artery. J Shoulder Elbow Surg 1997; 6(6): 564-9.
[58] Rockwood CA Jr, Groh GI, Wirth MA, Grassi FA. Resection arthroplasty of the sternoclavicular joint. J Bone Joint Surg Am 1997; 79(3): 387-93.
[59] Dennis MG, Kummer FJ, Zuckerman JD. Dislocations of the sternoclavicular joint. Bull Hosp Jt Dis 2000; 59(3): 153-7.
[60] Renfree KJ, Wright TW. Anatomy and biomechanics of the acromioclavicular and sternoclavicular joints. Clin Sports Med 2003; 22(2): 219-37.
[61] Spencer EE, Kuhn JE, Huston LJ, Carpenter JE, Hughes RE. Ligamentous restraints to anterior and posterior translation of the sternoclavicular joint. J Shoulder Elbow Surg 2002; 11(1): 43-7.
[62] Spencer EE Jr, Kuhn JE. Biomechanical analysis of reconstructions for sternoclavicular joint instability. J Bone Joint Surg Am 2004; 86(1): 98-105.
[63] Selesnick FH, Jablon M, Frank C, Post M. Retrosternal dislocation of the clavicle. Report of four cases. J Bone Joint Surg Am 1984; 66(2): 287-91.
[64] Rockwood CA Jr. Injuries of the sternoclavicular joint.Rockwood and Green’s Fractures in Adults 3rd ed. 1991; 1253-307.
[65] Ballas R, Bonnel F. Endopelvic migration of a sternoclavicular K-wire. Case report and review of literature. Orthop Traumatol Surg Res 2012; 98(1): 118-21.
[66] Clark RL, Milgram JW, Yawn DH. Fatal aortic perforation and cardiac tamponade due to a Kirschner wire migrating from the right sternoclavicular joint. South Med J 1974; 67(3): 316-8.
[67] Gerlach D, Wemhöner SR, Ogbuihi S. [2 cases of pericardial tamponade caused by migration of fracture wires from the sternoclavicular joint]. Z Rechtsmed 1984; 93(1): 53-60. [2 cases of pericardial tamponade caused by migration of fracture wires from the sternoclavicular joint].
[68] Janssens de Varebeke B, Van Osselaer G. Migration of Kirschner’s pin from the right sternoclavicular joint resulting in perforation of the pulmonary artery main trunk. Acta Chir Belg 1993; 93(6): 287-91.
[69] Leonard JW, Gifford RW Jr. Migration of a Kirschner wire from the clavicle into the pulmonary artery. Am J Cardiol 1965; 16(4): 598-600.
[70] Nettles JL, Linscheid RL. Sternoclavicular dislocations. J Trauma 1968; 8(2): 158-64.
[71] Pate JW, Wilhite JL. Migration of a foreign body from the sternoclavicular joint to the heart: a case report. Am Surg 1969; 35(6): 448-9.
[72] Salvatore JE. Sternoclavicular joint dislocation. Clin Orthop Relat Res 1968; 58(58): 51-5.
[73] Smolle-Juettner FM, Hofer PH, Pinter H, Friehs G, Szyskowitz R. Intracardiac malpositioning of a sternoclavicular fixation wire. J Orthop Trauma 1992; 6(1): 102-5.
[74] Terra BB, Rodrigues LM, Pádua DVH, Martins MG, Teixeira JCM, De Nadai A. Sternoclavicular dislocation: case report and surgical technique. Revista Brasileira de Ortopedia (English Edition) 2015; 50(4): 472-7.
[75] Petri M, Greenspoon JA, Horan MP, Martetschläger F, Warth RJ, Millett PJ. Clinical outcomes after autograft reconstruction for sternoclavicular joint instability. J Shoulder Elbow Surg 2016; 25(3): 435-41.
[76] Martetschläger F, Braun S, Lorenz S, Lenich A, Imhoff AB. Novel technique for sternoclavicular joint reconstruction using a gracilis tendon autograft. Knee Surg Sports Traumatol Arthrosc 2016; 24(7): 2225-30.
[77] Sabatini JB, Shung JR, Clay TB, Oladeji LO, Minnich DJ, Ponce BA. Outcomes of augmented allograft figure-of-eight sternoclavicular joint reconstruction. J Shoulder Elbow Surg 2015; 24(6): 902-7.
[78] Kawaguchi K, Tanaka S, Yoshitomi H, et al. Double figure-of-eight reconstruction technique for chronic anterior sternoclavicular joint dislocation. Knee Surg Sports Traumatol Arthrosc 2015; 23(5): 1559-62.
[79] Sanchez-Sotelo J, Baghdadi Y, Nguyen NTV. Sternoclavicular joint allograft reconstruction using the sternal docking technique. JSES Open Access 2018; 2(4): 190-3.
[80] Lacheta L, Dekker TJ, Goldenberg BT, et al. Minimum 5-Year Clinical Outcomes, Survivorship, and Return to Sports After Hamstring Tendon Autograft Reconstruction for Sternoclavicular Joint Instability. Am J Sports Med 2020; 48(4): 939-46.
[81] Cruz MF, Erdeljac J, Williams R, Brown M, Bolgla L. Posterior Sternoclavicular Joint Dislocation in a Division I Football Player: A Case Report. Int J Sports Phys Ther 2015; 10(5): 700-11.
[82] Yang JS, Bogunovic L, Brophy RH, Wright RW, Scott R, Matava M. A Case of Posterior Sternoclavicular Dislocation in a Professional American Football Player. Sports Health 2015; 7(4): 318-25.