J Korean Orthop Assoc.  2017 Apr;52(2):178-184. 10.4055/jkoa.2017.52.2.178.

Comparison of Anterior Translation among Three Sternoclavicular Reconstruction Methods in Cadaver Study

• Kim DS
• Chung HJ
• Park IH
• Shin JS
• Lee JP
• Jang YH

• KMID: 2438983
• DOI: http://doi.org/10.4055/jkoa.2017.52.2.178

Abstract

PURPOSE
Currently, biomechanics and function comparison of the reconstruction of structures play important roles in the sternoclavicular joint stability is not much. In order to confirm the improvement in the functional aspects of the sternoclavicular joint after the three most widely used reconstruction methods, we measured the degree of anterior translation of the sternoclavicular joint after the operation using cadavers.
MATERIALS AND METHODS
We studied 24 sternoclavicular joints in the cadavers. First, we measured the anterior translation of the clavicle, which was compared with the sternum in 24 normal sternoclavicular joints. We divided the cadaver into three groups and performed each of the three current operations: figure of eight hamastring tendon reconstruction operation (Group 1), subclavius tendon reconstruction operation (Group 2), and hamstring tendon reconstruction operation (Group 3); then we compared the degree of anterior translation in each group. We did the measurement by adding 10 degrees to the glenohumeral joint each time from 0 degrees to 90 degrees.
RESULTS
In the normal joint, the clavicle was significantly ascended compared with the sternum. The Group 1 had a 1.68±0.25 mm anterior translation while the Group 2 had 1.81±0.23 mm and Group 3 had 2.8±0.58 mm (Group 1: p=0.004, Group 2: p=0.001, Group 3: p=0.002). The Group 1 showed a low ascending rate of up to 60 degrees, which showed no significant difference with that of the normal joint. However, after 60 degrees, the ascending rate showed a significant increase. In the case of Group 2, there was no significant difference with normal joint of up to 50 degrees. Group 3 showed significant anterior ascending from 20 degree.
CONCLUSION
Through measuring the anterior translation of subjects that underwent three representative sternoclavicular joint reconstructions, we found that the result from the Group 1 was most comparable normal translation of the sternoclavicular joint.

Keyword

kinematics; biomechanics; dislocation; sternoclavicular joint; cadaver model

MeSH Terms

Biomechanical Phenomena
Cadaver*
Clavicle
Dislocations
Joints
Methods*
Shoulder Joint
Sternoclavicular Joint
Sternum
Tendons

Figure

• 

  Figure 1 Five reflective bony markers were attached to the proximal and distal sternum and clavicle to recognize the axis. Vicon motion analysis system (Vicon Motion System, UK) with 6 cameras (MXT10 2 megapixel camera).

• 

  Figure 2 Drill two 3- to 4-mm diameter drill-holes for each sternum and clavicle. Pass a hamstring tendon through the holes in the sternum and clavicle in a figure 8 shape, then bind the hamstring tendon (Hamstring tendon figure of eight reconstruction).

• 

  Figure 3 Start drilling in a superior to inferior direction in accordance with the position of the subclavius tendon. Impale the subclavius tendon in an inferior to superior direction at the drill hole and use one No. 2 Ethibond to suture up and bind subclavius tendon (subclavius tendon reconstruction).

• 

  Figure 4 In a superior to inferior direction, use the drill to make a hole at the medial side of the clavicle and pass the hamstring tendon through the hole. Then, sling the hamstring tendon around the first rib while maintaining tight tension. Use No. 2 Ethibond to bind the hamstring tendon. The remaining tendon was used for a simple sling around the clavicle and the first rib at the outer radius of the reconstruction site (Hamstring tendon sling reconstruction).

• 

  Figure 5 Anterior translation of the clavicle during the coronal plane abduction of glenohumeral joint.

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