Sternoclavicular joint osteoarthritis with associated anterior instability treated with open excision arthroplasty and an augmented anterior capsular plication

The majority of patients with symptomatic sternoclavicular joint (SCJ) osteoarthritis (OA) can be successfully treated nonoperatively. For patients who remain symptomatic, an arthroscopic or open SCJ excision arthroplasty is usually successful. However, a standard SCJ excision arthroplasty is contraindicated in patients with associated instability. We have developed an open intracapsular excision arthroplasty and augmented capsular plication technique to treat patients with SCJ OA and associated instability. Between 2018 and 2022, patients who underwent an open excision arthroplasty and augmented capsular plication for symptomatic SCJ OA with associated instability, diagnosed by magnetic resonance imaging scan, were reviewed. Patient-reported outcomes were assessed by Rockwood SCJ scale, Oxford Shoulder Instability Score (OSIS), short version of the Disabilities of the Arm, Shoulder and Hand (QuickDASH), and Single Assessment Numeric Evaluation (SANE) scores. Survivorship was defined as no instability or ongoing pain and no revision surgery. A total of 27 patients who underwent surgery and were available at final follow-up were included in the study. The mean age at surgery was 53.4 years (range 30-76), and the mean follow-up, 45.8 months (range 25-79). At final follow-up, the mean Rockwood SCJ score had increased from 7.2 (6-9) to 14.1 (10-15, standard deviation 1.2), the QuickDASH score had reduced from 33.2 (45.0-18.2) to 4.3 (0-12.2), the mean OSIS score had increased from 21.7 (18-37) to 45.3 (36-48), and the mean SANE score had increased from 51.0 (30-70) to 88.8 (55-100). These all reached statistical significance. The repair and construct survivorship was 98%. All of the patients, apart from 2, were satisfied with the results of their procedure. Undertaking an open excision arthroplasty and augmented capsular repair for patients with symptomatic SCJ OA and associated instability refractory to nonoperative treatment provides a satisfactory outcome with regard to joint instability, pain, and clinical outcomes.