BACKGROUND Instability of the sternoclavicular (SC) joint is a rare but potentially devastating pathologic condition, particularly when it occurs in young or active patients, where it can lead to persistent pain and impairment of shoulder function. SC joint reconstruction using a hamstring tendon autograft is a commonly used treatment option, but midterm results are still lacking. PURPOSE/HYPOTHESIS The purpose of this study was to assess the clinical outcomes, survivorship, and return-to-sports rate after SC joint reconstruction using a hamstring tendon autograft in patients suffering from SC joint instability. We hypothesized that SC joint reconstruction would result in good clinical outcomes, high rate of survivorship, and a high rate of return to sports. STUDY DESIGN Case series; Level of evidence, 4. METHODS All patients who underwent SC joint reconstruction with a hamstring tendon autograft for SC joint instability, with a minimum 5-year follow-up, were included. Patient-reported outcomes were assessed prospectively by the use of the American Shoulder and Elbow Surgeons (ASES) score, Single Assessment Numerical Evaluation (SANE) score, short version of the Disabilities of the Arm, Shoulder and Hand (QuickDASH) score, 12-Item Short Form Health Survey (SF-12) physical component summary (PCS), and patient satisfaction. Survivorship of reconstruction was defined as no further revision surgery or clinical failure such as recurrent instability or subluxation events. Return to sports and pain were assessed using a customized questionnaire. RESULTS A total of 22 shoulders that underwent SC joint reconstruction, with a mean patient age of 31.3 years (range, 15.8-57.0 years) at the time of surgery, were included. At the final evaluation, 18 shoulders, with a mean follow-up of 6.0 years (range, 5.0-7.3 years), completed a minimum 5-year follow-up. All clinical outcome scores improved significantly from preoperatively to postoperatively: ASES (50.0 to 91.0; P = .005), SANE (45.9 to 86.0; P = .007), QuickDASH (44.2 to 12.1; P = .003), and SF-12 PCS (39.4 to 50.9; P = .001). Median postoperative satisfaction was 9 (range, 7-10). The construct survivorship was 90% at 5-year follow-up. There were 2 patients with failed treatment at 82 and 336 days postoperatively because of instability or pain who underwent revision SC joint reconstruction and capsulorrhaphy. Another patient had a superficial wound infection, which was debrided once and resulted in a good clinical outcome. Of the patients who answered optional sports activity questions, 15 (17 shoulders, 77%) participated in recreational or professional sports before the injury. At final follow-up, 14 patients (16 of 17 shoulders, 94%) returned to their preinjury level of sports. The visual analog scale score for pain today (P = .004) and pain at its worst (P = .004) improved significantly from preoperatively to postoperatively. CONCLUSION SC joint reconstruction with a hamstring tendon autograft for SC joint instability resulted in significantly improved clinical outcomes with high patient satisfaction and 90% survivorship at midterm follow-up. Furthermore, 94% of this young and high-demand patient population returned to their previous level of sports. Concerns in terms of advanced postinstability arthritis were not confirmed because a significant decrease in pain was found after a minimum 5-year follow-up.

中文翻译：

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Ham绳肌腱自体重建后重建肩锁关节不稳的最低5年临床结果，生存率和重返运动场。

背景技术锁骨（SC）关节不稳定是一种罕见但可能具有破坏性的病理状况，尤其是在年轻或活跃患者中发生时，可能导致持续的疼痛和肩部功能受损。使用a绳肌腱自体移植重建SC关节是一种常用的治疗选择，但仍缺乏中期结果。目的/假设本研究的目的是评估使用a绳肌腱自体移植重建SC关节不稳定患者的SC关节重建后的临床结局，存活率和运动返回率。我们假设，SC关节重建将导致良好的临床结果，较高的存活率和较高的运动回报率。研究设计案例系列；证据水平4。方法纳入所有因自发性关节关节不稳而行绳肌腱自体移植的SC关节重建的患者，并至少随访5年。通过使用美国肩肘外科医师（ASES）评分，单次评估数值评估（SANE）评分，手臂，肩部和手部残疾（QuickDASH）评分的简短版本，12-项目简短形式健康调查（SF-12）物理组件摘要（PCS）和患者满意度。重建的生存期被定义为不再进行翻修手术或临床失败，例如复发性不稳定或半脱位事件。使用定制的问卷评估了恢复运动和疼痛的情况。结果共有22个肩关节接受了SC关节重建，平均患者年龄为31岁。包括手术时的3年（范围15.8-57.0年）。在最终评估中，平均随访6.0年（范围5.0-7.3年）的18个肩关节完成了至少5年的随访。从术前到术后，所有临床结局评分均得到显着改善：ASES（50.0至91.0； P = .005），SANE（45.9至86.0； P = .007），QuickDASH（44.2至12.1； P = .003）和SF- 12个PCS（39.4至50.9； P = 0.001）。术后中位满意度为9（范围7-10）。在5年的随访中，构造物的存活率为90％。2例因不稳定或疼痛而在术后82和336天治疗失败的患者接受了SC关节重建和囊膜翻修术。另一例患者有浅表伤口感染，该伤口清创一次并取得了良好的临床效果。在回答了可选的体育活动问题的患者中，有15名（17肩，占77％）在受伤前参加了休闲或专业运动。在最后的随访中，有14名患者（17肩中的16例，占94％）恢复到运动前的运动水平。从术前到术后，今天的疼痛（P = .004）和最严重疼痛（P = .004）的视觉模拟量表评分均有明显改善。结论自体绳肌腱移植治疗SC关节不稳可显着改善临床结局，在中期随访时患者满意度高，存活率达90％。此外，这些年轻人和高需求患者中有94％返回到以前的运动水平。