Predictors of Clinical Outcomes and Quality of Life After Sternoclavicular Joint Reconstruction With Hamstring Tendon Autograft

Marco-Christopher Rupp, Annabel R. Geissbuhler, Joan C. Rutledge, Marilee P. Horan, Phob Ganokroj, Peter Chang, Matthew T. Provencher, Peter J. Millett
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Abstract

Background:Anterior instability of the sternoclavicular joint (SCJ) is a rare but potentially devastating pathological condition, particularly when it occurs in young or active patients. SCJ reconstruction using hamstring tendon autograft is a commonly used treatment option, yet to date results are limited to small case series. Studies on baseline, preoperative factors and their association with postoperative outcome are limited.Purpose:To assess the midterm clinical outcomes and survivorship after SCJ reconstruction using hamstring tendon autograft in patients experiencing anterior SCJ instability and to determine whether baseline patient or causative factors are associated with postoperative outcomes or patient satisfaction.Study Design:Case series; Level of evidence, 4.Methods:Patients who underwent SCJ reconstruction with a hamstring tendon autograft for anterior SCJ instability between October 2005 and October 2020 were included in this retrospective single-center study. At a minimum of 2 years postoperatively, clinical outcomes were collected, including the following patient-reported outcomes (PROs): the 12-Item Short Form Survey (SF-12) score; American Shoulder and Elbow Surgeons (ASES) score; Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) score; Single Assessment Numeric Evaluation (SANE) score; and visual analog scale (VAS) pain score. Subjective postoperative satisfaction with the procedure was quantified on a scale from 0 (very unsatisfied) to 10 (very satisfied). The predictive role of patient factors, including age, sex, and injury in dominant arm, on postoperative PROs and satisfaction at short-term follow-up was evaluated using multiple linear regression.Results:A total of 49 patients (mean age, 29.6 ± 16.2 years; range 13.8-67.1 years; 27 females) were included in the final analysis. At a mean follow-up of 3.9 ± 2.1 years, all PROs had significantly improved, including the mean SF-12 Physical Component Summary score (40.4 ± 6.8 to 52.6 ± 6.9; P < .001), ASES score (54.9 ± 20.4 to 91.0 ± 11.3; P < .001), QuickDASH score (41.2 ± 18.5 to 10.2 ± 9.1; P < .001); SANE score (50.2 ± 21.1 to 88.3 ± 8.8; P < .001), VAS pain score (4.4 ± 2.6 to 0.8 ± 1.4; P < .001), and VAS pain score at its worst (7.4 ± 2.5 to 3.3 ± 2.6; P < .001). The median postoperative satisfaction score was 9 (range, 1-10). Revision-free survivorship was 95.9%. Male patients had a significantly lower VAS pain score at its worst compared with female patients (2.6 ± 2.6 vs 4.1 ± 2.4; P = .045); higher age was significantly correlated with a worse QuickDASH score (correlation coefficient, 0.314; P = .036). Overhead athletes had a significantly lower propensity to return to sport compared with nonoverhead athletes ( P = .043), with only 45% of the overhead athletes returning to a level similar to their preinjury level, whereas 81% of the nonoverhead athletes were able to do so.Conclusion:The significant improvements in clinical and sport-specific outcomes and high patient satisfaction after SCJ reconstruction with a hamstring tendon autograft demonstrate the success of this procedure in treating anterior SCJ instability. Male sex and younger patient age are associated with superior outcomes, while overhead athletes have to be counseled about difficulties of returning to preinjury level of sport postoperatively.
腘绳肌腱自体移植胸锁关节重建术后临床疗效和生活质量的预测因素
背景:胸锁关节(SCJ)前方失稳是一种罕见但可能造成严重后果的病理情况,尤其是发生在年轻或活跃的患者身上。使用腘绳肌腱自体移植进行胸锁关节重建是一种常用的治疗方法,但迄今为止的结果仅限于小型病例系列。目的:评估腘绳肌腱自体移植进行SCJ重建术后的中期临床疗效和存活率,并确定患者基线或致病因素是否与术后疗效或患者满意度相关。研究设计:病例系列;证据级别:4.方法:这项回顾性单中心研究纳入了2005年10月至2020年10月期间因SCJ前侧不稳而接受腘绳肌腱自体移植进行SCJ重建的患者。在术后至少两年收集临床结果,包括以下患者报告结果(PROs):12项简表调查(SF-12)评分;美国肩肘外科医生(ASES)评分;手臂、肩部和手部快速残疾(QuickDASH)评分;单次数字评估(SANE)评分;视觉模拟量表(VAS)疼痛评分。术后对手术的主观满意度按 0 分(非常不满意)到 10 分(非常满意)进行量化。使用多元线性回归评估了患者因素(包括年龄、性别和优势臂损伤)对术后主观评分和短期随访满意度的预测作用。在平均 3.9 ± 2.1 年的随访中,所有 PROs 均有明显改善,包括 SF-12 物理组件摘要平均得分(40.4 ± 6.8 到 52.6 ± 6.9;P < .001)、ASES 得分(54.9 ± 20.4 到 91.0 ± 11.3;P < .001)、QuickDASH 评分(41.2 ± 18.5 到 10.2 ± 9.1;P <;.001)、SANE 评分(50.2 ± 21.1 到 88.3 ± 8.8;P <;.001)、VAS 疼痛评分(4.4 ± 2.6 到 0.8 ± 1.4;P <;.001)和最严重时的 VAS 疼痛评分(7.4 ± 2.5 到 3.3 ± 2.6;P <;.001)。术后满意度中位数为 9 分(1-10 分不等)。无翻修存活率为 95.9%。男性患者最严重时的 VAS 疼痛评分明显低于女性患者(2.6 ± 2.6 vs 4.1 ± 2.4;P = .045);年龄越大,QuickDASH 评分越低(相关系数为 0.314;P = .036)。结论:使用腘绳肌腱自体移植物重建SCJ后,临床和运动特异性结果明显改善,患者满意度高,这表明该手术在治疗SCJ前侧不稳方面取得了成功。男性和年龄较小的患者可获得更好的疗效,但必须告知高空运动员术后很难恢复到受伤前的运动水平。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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