Published online Jul 18, 2017. doi: 10.5312/wjo.v8.i7.536
Peer-review started: November 23, 2016
First decision: February 15, 2017
Revised: April 17, 2017
Accepted: May 3, 2017
Article in press: May 5, 2017
Published online: July 18, 2017
To investigate if there are typical degenerative changes in the ageing sternoclavicular joint (SCJ), potentially accessible for arthroscopic intervention.
Both SCJs were obtained from 39 human cadavers (mean age: 79 years, range: 59-96, 13 F/26 M). Each frozen specimen was divided frontally with a band saw, so that both SCJs were opened in the same section through the center of the discs. After thawing of the specimens, the condition of the discs was evaluated by probing and visual inspection. The articular cartilages were graded according to Outerbridge, and disc attachments were probed. Cranio-caudal heights of the joint cartilages were measured. Superior motion of the clavicle with inferior movement of the lateral clavicle was measured.
Degenerative changes of the discs were common. Only 22 discs (28%) were fully attached and the discs were thickest superiorly. We found a typical pattern: Detachment of the disc inferiorly in connection with thinning, fraying and fragmentation of the inferior part of the disc, and detachment from the anterior and/or posterior capsule. Severe joint cartilage degeneration ≥ grade 3 was more common on the clavicular side (73%) than on the sternal side (54%) of the joint. In cadavers < 70 years 75% had ≤ grade 2 changes while this was the case for only 19% aged 90 years or more. There was no difference in cartilage changes when right and left sides were compared, and no difference between sexes. Only one cadaver - a woman aged 60 years - had normal cartilages.
Changes in the disc and cartilages can be treated by resection of disc, cartilage, intraarticular osteophytes or medial clavicle end. Reattachment of a degenerated disc is not possible.
Core tip: Arthroscopic treatment is an option in patients with symptoms from the ageing sternoclavicular joint (SCJ). However, knowledge of age-related changes is essential for planning of such arthroscopic procedures. In 78 human cadaveric SCJs with a mean age of 79 years (range: 59-96 years) we found that degenerative changes of the discs were common, in particular inferior detachment, and only 28% were fully attached. Severe cartilage degeneration was more common on the clavicular than the sternal side. When there was inferior detachment of the disc, we observed increased supero-medial gliding of the clavicle. We conclude that a torn disc or degenerated articular cartilage might be treated by arthroscopic resection, debridement and clavicle end resection. Reattachment of a degenerated disc is not possible.