In more severe cases of osteoarthritis of the sternoclavicular joint, which do not respond to conservative treatment, arthroscopic excision can be safe and effective, a new study finds.
The study, “Arthroscopic Excision Arthroplasty of the Sternoclavicular Joint for Osteoarthritis: A Case Series of 50 Patients,” was published in the May 2020 issue of the Arthroscopy journal.
The researchers analyzed the results of a consecutive series of 50 patients (26 female, 24 male) who underwent arthroscopic excision to treat their osteoarthritis of the sternoclavicular joint. The patients all also received physiotherapy and at least one ultrasound-guided cortisone injection.
Surgery was outpatient and did not require shoulder immobilization. The researchers assessed the patients before surgery and at final follow-up using the Constant, Rockwood SCJ, and Quick-DASH scores. Mean follow-up was 41.8 months.
Forty-five patients completed the final follow-up. Overall, the median Constant score increased from 55 (range 37-79) to 72 (range 38-92), Rockwood score from 6 (range 4-9) to 13 (range 4-15), and Quick-DASH 36 (range 18-69) to 12 (range 0-51). None of the patients reported any complications or problems with joint instability and 44 of the 45 patients said they were pleased with the results of the study.
The researchers wrote, “The results of this study show that arthroscopic excision arthroplasty of the sternoclavicular joint is a satisfactory treatment for primary sternoclavicular joint osteoarthritis refractory to conservative treatment.”
Justin W. Arner, M.D., and Peter J. Millet, M.D. in an accompanying editorial, “Sternoclavicular Joint Osteoarthritis Surgical Treatment Offers Benefits As Well As Risks,” wrote about the risks and benefits of taking an arthroscopic surgical approach as opposed to an open one.
They congratulated the researchers on the study which is the largest series of cases so far but noted that “open resection provides most surgeons with confidence that a parallel and adequate resection is accomplished without damage to the posterior, superior and inferior costoclavicular ligament, as well as the neurovascular structures.”
“For the experienced arthroscopist, it is certainly a great option to be able to perform this arthroscopically as described in the article by Tytherleigh-Strong et al,” they added.
“Both arthroscopic and open approaches can result in excellent clinical outcomes for patients with symptomatic sternoclavicular arthritis. We prefer an open approach because an arthroscopic approach may have a greater risk of complications. In our experience, after surgical treatment of sternoclavicular arthritis, 67% of patients return to sport at 2-year minimum follow-up.”
