Although the sternoclavicular joint is one of the most stable joints in the human body, it may become unstable via atraumatic or traumatic means. Sternoclavicular joint instability is associated with a considerable risk for morbidity because of the proximity of the clavicle and two important mediastinal vascular and visceral structures. Although sternoclavicular joint instability is primarily managed nonsurgically, surgical treatment is indicated in symptomatic patients. Several methods of surgical fixation have been described, including hardware fixation, medial clavicle resection, and ligament reconstruction (Wolf technique and Kuhn technique).

This video demonstrates revision sternoclavicular reconstruction via the Wolf technique in a college baseball player. The procedure was performed with the use of semitendinosus allograft through bone tunnels in the manubrium and the clavicle. Careful attention must be paid to the mediastinal structures, which are located deep to the manubrium. A vascular surgeon must be immediately available during sternoclavicular reconstruction.

Our clinical series included nine patients (6 males [66.7%], 3 females [33.3%]) with chronic sternoclavicular joint instability who underwent sternoclavicular reconstruction via the Wolf technique. The mean patient age was 38 years. Six patients (66.7%) were available for follow-up. Outcome scores included the American Shoulder and Elbow Surgeons score; the Quick Disabilities of the Arm, Shoulder and Hand score; and the visual analogue scale for pain. Mean follow-up was 42.1 months ± 30.8 months. At final follow-up, the mean American Shoulder and Elbow Surgeons score was 89.1 ± 18.1; the Quick Disabilities of the Arm, Shoulder and Hand score was 12.1 ± 16.0; and the and visual analogue score for pain was 1.2 ± 3.0. One patient underwent revision surgery for continued instability at 11 weeks postoperatively. On evaluation of the reconstruction, evidence of sternal drill hole coalescence was noted. Revision reconstruction was performed, and the patient recovered uneventfully. One patient experienced continued sternoclavicular joint pain and required repeated sternoclavicular joint cortisone injections.