Good Clinical and Functional Outcomes With Low Rates of Recurrent Instability and Revision Surgery After Sternoclavicular Reconstruction or Repair for the Treatment of Instability: A Systematic Review
Bibliographic record
Abstract
PURPOSE: To evaluate clinical and functional outcomes after sternoclavicular joint (SCJ) reconstruction or repair and to calculate the rates of recurrent instability, revision surgery, return to sport (RTS), and return to work (RTW) after SCJ reconstruction or repair for the treatment of SCJ instability. METHODS: A systematic review of the literature based on the Preferred Reporting Items for Systematic Reviews and Meta Analyses was conducted using PubMed, Embase, and the Cochrane Library. Studies that evaluated the clinical and functional outcomes after SCJ reconstruction or repair for the treatment of SCJ instability were included. Data regarding study and patient characteristics, surgical management, clinical and functional outcomes as well as RTS and RTW were collected. Because of the heterogeneity of the studies included, patient-reported outcome measurements and complication rates were reported as ranges. RESULTS: In total, ten studies (8 with Level IV evidence and 2 with Level III evidence) with 150 patients were included for analysis, of which a reconstruction was performed in 8 studies and a repair was performed in 2 studies. Mean patient age ranged from 22.2 to 42 years (range, 11-73 years), and the mean follow-up time ranged from mean 28.2 to 94.5 months (range, 24 months to 13 years). A traumatic event was the most common source for SCJ instability across all studies (43.8-100%). Surgery was performed more often for anterior SCJ instability than for posterior SCJ instability. The short version of the Disabilities of the Arm, Shoulder and Hand and American Shoulder and Elbow Surgeons scores were the most commonly reported functional outcome parameters and improved from mean 44.2 to 2.3-12.1 and 44.8-50.0 to 70.8-94.8, respectively. Pain (assessed via visual analog scale) decreased from mean 3.8-6.8 to 0-2.8 postoperatively. The recurrent instability rate was 0-10.0% and the revision SCJ surgery rate was 0-16.7%. Rates of RTS (44.4-100%) and RTW (42.9-75.0%) varied greatly among studies. CONCLUSIONS: Reconstruction or repair of the SCJ for the treatment of SCJ instability is associated with good-to-excellent clinical and functional outcomes, low rates of instability recurrence and of revision SCJ surgery, as well as moderate-to-high RTS and RTW rates. LEVEL OF EVIDENCE: Level IV, systematic review of Level III and IV studies.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.009 | 0.046 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.011 | 0.012 |
| Bibliometrics | 0.010 | 0.010 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.003 | 0.002 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.002 | 0.001 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".