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Sternoclavicular Joint Disorders

Sternoclavicular joint instability, dislocation and arthritis (corpus-synthesised).

Overview

Sternoclavicular joint disorders encompass a spectrum from traumatic disruptions to atraumatic instability and septic arthritis, requiring distinct management algorithms based on etiology and patient age. Reconstruction utilizing osseous and soft tissue grafts, including synthetic options or sternocleidomastoid tendon, effectively restores stability after excessive medial clavicle resection or chronic anterior instability [1, 3, 7]. For septic arthritis, resection arthroplasty offers a safe and effective pathway to infection eradication with low complication rates and good functional recovery [9]. In pediatric populations, most physeal injuries heal without intervention, though accurate initial diagnosis is critical for posterior injuries where rigid clavicular fixation or single locking plate open reduction provides safe, stable outcomes [6, 11, 14, 16].

Posterior dislocations represent a surgical emergency requiring prompt closed or open reduction to prevent mediastinal complications [6]. Conversely, atraumatic dislocations are managed nonoperatively, as surgical outcomes are poor and conservative treatment yields improved symptoms and function over time [5]. Unusual trauma constellations may involve isolated clavicle fractures with concurrent joint subluxation and nerve injury, necessitating comprehensive evaluation [4]. Long-term data confirms that reconstruction for instability results in excellent shoulder function, low pain levels, and high patient satisfaction at a minimum of 10 years postoperatively [12]. Intraoperative assessment using O-arm imaging facilitates adequate reduction in pediatric posterior injuries [14].

Anatomy & Pathophysiology

Traumatic dislocation of the sternoclavicular joint accounts for only 3% of injuries to the shoulder girdle [15]. The joint is subject to both traumatic and atraumatic conditions [8] as well as non-traumatic conditions [2]. Posterior dislocation is potentially life-threatening due to proximity to vital mediastinal structures [15]. An unusual constellation of shoulder girdle trauma can involve an initially isolated clavicle fracture accompanied by sternoclavicular joint subluxation and long thoracic nerve injury [4]. Biomechanical models of the sternoclavicular joint are useful references to better understand the relationship between ligamentous injuries and subluxations [21].

Reconstruction Techniques: Surgical stabilization techniques using autologous tendon grafts have shown to be safe and reliable [22]. A unicortical reconstruction using synthetic graft is a relatively safe technique that allows for early postoperative functional rehabilitation [3]. Reconstruction after excessive medial clavicle resection using a combination of osseous and soft tissue reconstruction can adequately restore sternoclavicular stability [1]. The double figure-of-eight reconstruction technique for chronic anterior dislocation provides long-term joint stabilization, restores full range of motion, and resolves most symptoms of discomfort [17]. Arthroscopically intended treatment provides significant and sustained improvements in pain and function [27]. Arthroscopic resection arthroplasty offers advantages including minimal tissue dissection, maintenance of joint stability, and improved cosmesis [28]. Resection arthroplasty for septic arthritis is safe and effective, resulting in a low rate of complications, eradication of infection, and good functional recovery of the shoulder [9]. A specific operative procedure based on magnetic resonance imaging diagnosis and structural anatomic magnetic resonance imaging findings provides a satisfactory outcome with regards to joint stability and clinical outcomes [23].

Outcomes and Complications: At a minimum of 10 years postoperatively, shoulder function after reconstruction for instability was excellent, pain levels were low, and patient satisfaction was high [12]. The Short version of the Disabilities of the Arm, Shoulder and Hand score improved from a mean of 44.2 to 2.3-12.1 after reconstruction or repair for instability [25]. The American Shoulder and Elbow Surgeons score improved from a mean of 44.8-50.0 to 70.8-94.8 after reconstruction or repair for instability [25]. K-wire osteosynthesis for scapular belt functional lesions raises questions due to migration risks, which can have fatal consequences [26]. When complications after sternoclavicular surgery are left untreated, they can lead to persistent complaints or recurrent instability due to failure of reconstruction [29].

Classification

Anatomical Context: The sternoclavicular joint serves as the only osseous connection between the axial skeleton and the upper limb [19]. It is a synovial, saddle-like joint with robust posterior ligamentous stabilizers and a fibrocartilaginous disc [19]. Traumatic dislocation of this joint accounts for only 3% of injuries to the shoulder girdle [15].

Dislocation vs. Physeal Injury: Instability of the sternoclavicular joint is rare and can be difficult to distinguish from medial clavicular physeal or metaphyseal fracture-separation [10]. Proper recognition and treatment of sternoclavicular joint instability are vital as these injuries may be life-threatening [10]. Most physeal injuries of the sternoclavicular joint will heal with time without surgical intervention [6].

Posterior Dislocation Management: Posterior dislocation of the sternoclavicular joint is potentially life-threatening due to proximity to vital mediastinal structures [15]. Posterior dislocation of the sternoclavicular joint requires prompt closed or open reduction [6]. Open reduction and stabilisation should be considered at the outset if retrosternal dislocation of the sternoclavicular joint occurs in the context of underlying generalised ligamentous laxity [13].

Anterior Dislocation Management: Nonoperative treatment of atraumatic sternoclavicular dislocation results in improved symptoms and function over time [5]. No alternative treatment is currently recommended for atraumatic sternoclavicular dislocation due to poor surgical outcomes [5].

Surgical Reconstruction Techniques: Open reduction and fixation with a single locking plate for the treatment of traumatic sternoclavicular joint dislocation is a safe, relatively simple surgical procedure that can lead to satisfactory outcomes [16]. Rigid clavicular fixation is a safe and effective treatment option for anterior sternoclavicular joint disruption with ipsilateral medial clavicle fracture in an adolescent [11]. A combination of osseous and soft tissue reconstruction can adequately restore sternoclavicular stability in the setting of persistent instability after excessive medial clavicle resection [1]. A unicortical sternoclavicular joint reconstruction using synthetic graft is a relatively safe technique that allows for early postoperative functional rehabilitation [3]. The double figure-of-eight reconstruction technique for chronic anterior sternoclavicular joint dislocation provides long-term joint stabilization, restores full range of motion, and resolves most symptoms of discomfort [17].

Other Considerations: An unusual constellation of shoulder girdle trauma can involve an initially isolated clavicle fracture accompanied by sternoclavicular joint subluxation and long thoracic nerve injury [4].

Clinical Presentation

The sternoclavicular (SCJ) joint serves as the sole osseous connection between the axial skeleton and the upper limb [19]. Anatomically, it is a synovial, saddle-like joint containing a fibrocartilaginous disc and possessing robust posterior ligamentous stabilizers [19]. Traumatic dislocation of this joint accounts for only 3% of injuries to the shoulder girdle [15]. SCJ swellings may arise from both traumatic and non-traumatic pathologies [2], while osteoarthritis must be considered when utilizing CT scans to assess symptomatic SCJ pathology [20].

Acute Traumatic Injury: Posterior dislocation is potentially life-threatening due to proximity to vital mediastinal structures [15] and requires prompt closed or open reduction [6]. Accurate diagnosis on initial presentation is critical for pediatric posterior SCJ injuries [14]. Unusual constellations of shoulder girdle trauma may include ipsilateral clavicle fracture, SCJ subluxation, and long thoracic nerve injury [4].

Chronic and Atraumatic Instability: Instability of the SCJ is rare and can be difficult to distinguish from medial clavicular physeal or metaphyseal fracture-separation [10]. Persistent instability can occur following excessive medial clavicle resection [1]. Chronic debilitating anterior instability presents as a condition amenable to reconstruction with reliable pain relief and functional improvement [7]. Atraumatic dislocation presents with symptoms that improve over time with nonoperative treatment [5]. Retrosternal dislocation may occur in the context of underlying generalised ligamentous laxity [13].

Pediatric and Special Considerations: Most physeal injuries of the SCJ heal with time without surgical intervention [6]. However, SCJ instability may be life-threatening due to proximity to vital mediastinal structures [10].

Investigations

Plain radiography: Traumatic dislocation of the sternoclavicular joint accounts for only 3% of injuries to the shoulder girdle [15]. However, instability of the sternoclavicular joint can be difficult to distinguish from medial clavicular physeal or metaphyseal fracture-separation on initial imaging [10].

CT: Posterior dislocation of the sternoclavicular joint is potentially life-threatening due to proximity to vital mediastinal structures [15]. CT scans should be interpreted with consideration for the prevalence of osteoarthritis of the sternoclavicular joint when assessing symptomatic SCJ pathology [20].

MRI: Specific operative procedures based on magnetic resonance imaging diagnosis and structural anatomic magnetic resonance imaging findings provide satisfactory outcomes regarding joint stability and clinical outcomes [23].

Other Considerations: Biomechanical models of the sternoclavicular joint are useful references to better understand the relationship between ligamentous injuries and subluxations [21]. Accurate diagnosis on initial presentation is critical for pediatric posterior sternoclavicular joint injuries [14]. The O-arm is useful for assessing adequate intraoperative reduction in pediatric posterior sternoclavicular joint injuries [14].

Treatment

Non-Operative

Nonoperative management of atraumatic sternoclavicular dislocation yields improved symptoms and function over time [5], though no alternative treatment is currently recommended due to poor surgical outcomes [5]. Most physeal injuries of the sternoclavicular joint heal with time without surgical intervention [6].

Operative

Indications: Posterior dislocation of the sternoclavicular joint requires prompt closed or open reduction [6]. Open reduction and stabilisation should be considered at the outset for retrosternal dislocation in the context of underlying generalised ligamentous laxity [13]. Rigid clavicular fixation is indicated for anterior sternoclavicular joint disruption with ipsilateral medial clavicle fracture in adolescents [11].

Surgical Approach / Technique: Reconstruction using a combination of osseous and soft tissue components can adequately restore stability after excessive medial clavicle resection [1]. Techniques include sternoclavicular joint reconstruction using a sternocleidomastoid tendon graft, which is safe and offers reliable pain relief and functional improvement for chronic debilitating anterior instability [7]. A unicorticular reconstruction with synthetic graft is relatively safe and allows for early postoperative functional rehabilitation [3]. Open reduction and fixation with a single locking plate is a safe, relatively simple procedure for traumatic sternoclavicular joint dislocation that can lead to satisfactory outcomes [16]. For pediatric posterior injuries, the O-arm is useful for assessing adequate intraoperative reduction [14].

Adjuncts: Resection arthroplasty for septic arthritis of the sternoclavicular joint is safe and effective, resulting in a low rate of complications, eradication of infection, and good functional recovery [9].

Long-term Outcomes: At a minimum of 10 years postoperatively, sternoclavicular joint reconstruction for instability results in excellent shoulder function, low pain levels, and high patient satisfaction [12].

Complications

Instability: Persistent sternoclavicular instability may occur following excessive medial clavicle resection [1]. Differentiating sternoclavicular joint instability from medial clavicular physeal or metaphyseal fracture-separation is difficult, though the condition itself is rare [10]. Posterior dislocation constitutes a life-threatening injury requiring prompt closed or open reduction [6, 10]. In cases of retrosternal dislocation with underlying generalised ligamentous laxity, open reduction and stabilisation should be considered at the outset [13]. Conversely, atraumatic sternoclavicular dislocations are managed nonoperatively, which results in improved symptoms and function over time; no alternative surgical treatment is currently recommended due to poor outcomes [5]. Most physeal injuries of the sternoclavicular joint heal with time without surgical intervention [6].

Reconstruction Outcomes: Surgical stabilization using autologous tendon grafts is safe and reliable [22]. Reconstruction with a sternocleidomastoid tendon graft offers safe, reliable pain relief and functional improvement for chronic debilitating anterior instability [7], while semitendinosus tendon autografts have yielded excellent functional results at 1 year in high-performance athletes [18]. Synthetic graft reconstruction is relatively safe and permits early postoperative functional rehabilitation [3]. Long-term data indicate that at a minimum of 10 years postoperatively, shoulder function, pain levels, and patient satisfaction following sternoclavicular joint reconstruction for instability remain excellent, low, and high, respectively [12].

Infection: Resection arthroplasty for septic arthritis of the sternoclavicular joint is safe and effective, resulting in a low rate of complications [9]. This procedure successfully eradicates infection and facilitates good functional recovery of the shoulder [9].

Other Considerations: An unusual constellation of shoulder girdle trauma can include an initially isolated clavicle fracture accompanied by sternoclavicular joint subluxation and long thoracic nerve injury [4].

Recovery

Light activity (weeks): Patients undergoing reconstruction with a unicortical synthetic graft may begin early postoperative functional rehabilitation immediately, facilitating a quicker return to light activities [3]. For atraumatic dislocations managed nonoperatively, symptom improvement and functional gains occur progressively over time, allowing gradual resumption of desk work and light ADLs as tolerated [5].

Full activity (months): Return to high-performance sports is achievable; a judo patient treated with a semitendinosus tendon autograft returned to excellent functional status within 1 year [18]. Patients with chronic anterior instability treated via sternocleidomastoid tendon graft reconstruction report reliable functional improvement, supporting a return to full activity [7].

Complete recovery / outcome plateau (months): Long-term outcomes demonstrate stability and satisfaction, with shoulder function rated as excellent, pain levels low, and patient satisfaction high at a minimum of 10 years postoperatively [12]. Physeal injuries typically heal with time without surgical intervention, implying a natural plateau in recovery without operative delay [6].

Rehabilitation protocol: Early functional rehabilitation is permitted following unicortical reconstruction with synthetic grafts [3]. For posterior dislocations, prompt closed or open reduction is required to initiate the recovery timeline [6]. Nonoperative management of atraumatic dislocations relies on time-dependent healing rather than a structured surgical rehabilitation protocol [5].

Functional milestones: Reconstruction using a combination of osseous and soft tissue elements adequately restores stability following excessive medial clavicle resection [1]. Resection arthroplasty for septic arthritis yields good functional recovery of the shoulder with a low complication rate and eradication of infection [9]. Preservation or reconstruction of the costoclavicular ligament during medial clavicle resection is essential to achieve these satisfactory functional results [24].

Other Considerations: Nonoperative treatment is the sole recommendation for atraumatic sternoclavicular dislocation due to poor surgical outcomes with alternative treatments [5]. Reconstruction using a sternocleidomastoid tendon graft is specifically indicated for patients with chronic debilitating anterior instability to ensure safety and pain relief [7].

Key Evidence

  • [L5] In the setting of persistent sternoclavicular instability after excessive medial clavicle resection, a combination of osseous and soft tissue reconstruction can adequately restore sternoclavicular stability. (10.1016/j.eats.2021.08.020)
  • [L4] This review analyzes current evidence on traumatic and non-traumatic conditions affecting the sternoclavicular joint and provides an algorithm to manage these conditions. (10.1302/2058-5241.3.170078)
  • [L4] The authors report a technique for managing sternoclavicular joint injuries that is relatively safe and allows for early postoperative functional rehabilitation. (10.1177/1758573218790964)
  • [L4] The case represents an unusual constellation of shoulder girdle trauma where an initially isolated clavicle fracture was accompanied by sternoclavicular joint subluxation and long thoracic nerve injury. (10.1177/03635465000280062301)
  • [L4] Nonoperative treatment of atraumatic sternoclavicular dislocation results in improved symptoms and function over time, with no alternative treatment currently recommended due to poor surgical outcomes. (10.1016/j.jse.2019.04.060)
  • [L4] Most physeal injuries will heal with time without surgical intervention, but posterior dislocation of the sternoclavicular joint requires prompt closed or open reduction. (10.5435/00124635-199609000-00005)
  • [L4] Sternoclavicular joint reconstruction using a sternocleidomastoid tendon graft is safe and offers reliable pain relief and functional improvement for patients with chronic debilitating anterior instability of the sternoclavicular joint. (10.2106/jbjs.m.00681)
  • [L5] This review covers its anatomy, biomechanics, traumatic and atraumatic conditions, and management options. (10.1177/1758573218756880)
  • [L4] The procedure was found to be safe and effective, resulting in a low rate of complications, eradication of infection, and good functional recovery of the shoulder. (10.1016/j.jse.2011.05.020)
  • [L4] Instability of the sternoclavicular joint is rare and can be difficult to distinguish from medial clavicular physeal or metaphyseal fracture-separation; proper recognition and treatment are vital as these injuries may be life-threatening. (10.1302/0301-620x.95b6.31064)
  • [Case_report] This case adds to the limited literature and supports the role of rigid clavicular fixation as a safe and effective treatment option in similar presentations. (10.1016/j.xrrt.2026.100697)
  • [L4] At a minimum of 10 years postoperatively, shoulder function was excellent, pain levels were low, and patient satisfaction was high. (10.1177/03635465241299426)
  • [L4] This case suggests that open reduction and stabilisation should be considered at the outset if retrosternal dislocation of the sternoclavicular joint occurs in the context of underlying generalised ligamentous laxity. (10.1016/j.injury.2008.03.009)
  • [Case_report] This case highlights the importance of accurate diagnosis on initial presentation, the utility of the O-arm for assessing adequate intraoperative reduction, and describes a safe method of stable fixation for pediatric posterior sternoclavicular joint injuries. (10.1016/j.xrrt.2022.06.009)
  • [L4] Open reduction and fixation with a single locking plate for the treatment of traumatic sternoclavicular joint dislocation is a safe, relatively simple surgical procedure that can lead to satisfactory outcomes. (10.1186/s12891-017-1903-8)
  • [L4] This surgical technique provides long-term joint stabilization, restores full range of motion, and resolves most symptoms of discomfort. (10.1007/s00167-014-2979-4)
  • [Case_report] We have presented a case of dislocation of the sternoclavicular joint in a high-performance judo player who underwent reconstruction using the semitendinosus, with excellent functional results after 1 year of follow-up. (10.1007/s00167-008-0527-9)
  • [L4] The sternoclavicular joint (SCJ) serves as the only osseous connection between the axial skeleton and the upper limb and is a synovial, saddle-like joint with robust posterior ligamentous stabilizers and a fibrocartilaginous disc. (10.2106/jbjs.25.01025)
  • [L3] This should be taken into consideration when using a CT scan to assess a patient with symptomatic SCJ pathology. (10.1016/j.jse.2016.04.029)
  • [L4] Biomechanical models of the SC joint are useful references to better understand the relationship between ligamentous injuries and subluxations. (10.1016/s0899-7071(03)00096-2)
  • [L4] Surgical stabilization techniques for the SCJ using autologous tendon grafts have shown to be safe and reliable and make better patients' pain situation and shoulder function. (10.1007/s00167-015-3770-x)
  • [L4] Undertaking a specific operative procedure based on these findings provides a satisfactory outcome with regards to joint stability and clinical outcomes. (10.1016/j.jse.2025.04.018)
  • [L4] Preservation or reconstruction of the costoclavicular ligament is essential at the time of resection of the medial portion of the clavicle in order to obtain a satisfactory result. (10.2106/00004623-199703000-00011)
  • [L4] The short version of the Disabilities of the Arm, Shoulder and Hand and American Shoulder and Elbow Surgeons scores improved from mean 44.2 to 2.3-12.1 and 44.8-50.0 to 70.8-94.8, respectively. (10.1016/j.arthro.2025.03.061)
  • [Case_report] K-wire osteosynthesis for scapular belt functional lesions raises questions due to migration risks, which can have fatal consequences; this type of internal fixation should be abandoned in favor of other methods. (10.1016/j.otsr.2011.09.015)
  • [L4] Arthroscopically intended SCJ treatment provides significant and sustained improvements in pain and function. (10.1002/ksa.70298)
  • [Case_report] The procedure offers advantages including minimal tissue dissection, maintenance of joint stability, and improved cosmesis. (10.1016/j.eats.2013.09.019)
  • [L4] When left untreated, these complications can lead to persistent complaints or recurrent instability due to failure of reconstruction. (10.1016/j.jse.2020.09.015)

See Also

References

[1] Reconstruction of the Sternoclavicular Joint After Excessive Medial Clavicle Resection. Arthroscopy Techniques. 2021. DOI: 10.1016/j.eats.2021.08.020

[2] Swellings of the sternoclavicular joint: review of traumatic and non-traumatic pathologies. EFORT Open Reviews. 2018. DOI: 10.1302/2058-5241.3.170078

[3] The unicortical sternoclavicular joint reconstruction using synthetic graft. Shoulder & Elbow. 2018. DOI: 10.1177/1758573218790964

[4] Ipsilateral Clavicle Fracture, Sternoclavicular Joint Subluxation, and Long Thoracic Nerve Injury: An Unusual Constellation of Injuries Sustained during Wrestling. The American Journal of Sports Medicine. 2000. DOI: 10.1177/03635465000280062301

[5] Evolution of nonoperative treatment of atraumatic sternoclavicular dislocation. Journal of Shoulder and Elbow Surgery. 2019. DOI: 10.1016/j.jse.2019.04.060

[6] Acute and Chronic Traumatic Injuries of the Sternoclavicular Joint. Journal of the American Academy of Orthopaedic Surgeons. 1996. DOI: 10.5435/00124635-199609000-00005

[7] Clinical Outcome After Reconstruction for Sternoclavicular Joint Instability Using a Sternocleidomastoid Tendon Graft. Journal of Bone and Joint Surgery. 2014. DOI: 10.2106/jbjs.m.00681

[8] Sternoclavicular joint. Shoulder & Elbow. 2018. DOI: 10.1177/1758573218756880

[9] Resection arthroplasty for septic arthritis of the sternoclavicular joint. Journal of Shoulder and Elbow Surgery. 2012. DOI: 10.1016/j.jse.2011.05.020

[10] Instability of the sternoclavicular joint. The Bone & Joint Journal. 2013. DOI: 10.1302/0301-620x.95b6.31064

[11] Anterior sternoclavicular joint disruption with ipsilateral medial clavicle fracture in an adolescent: case report and literature review. JSES Reviews, Reports, and Techniques. 2026. DOI: 10.1016/j.xrrt.2026.100697

[12] Minimum 10-Year Clinical and Functional Outcomes, and Return to Sport After Sternoclavicular Joint Reconstruction for Sternoclavicular Joint Instability. The American Journal of Sports Medicine. 2025. DOI: 10.1177/03635465241299426

[13] Traumatic retrosternal dislocation of the sternoclavicular joint of a young adult with generalised ligamentous laxity. Injury Extra. 2008. DOI: 10.1016/j.injury.2008.03.009

[14] O-arm use in the surgical management of pediatric posterior sternoclavicular joint injury: a case report. JSES Reviews, Reports, and Techniques. 2022. DOI: 10.1016/j.xrrt.2022.06.009

[15] 19. Epidemiology, Clinical Evaluation, Imaging, and Classification of Sternoclavicular Joint Injuries. n.d..

[16] Locking plate for treating traumatic sternoclavicular joint dislocation: a case series. BMC Musculoskeletal Disorders. 2018. DOI: 10.1186/s12891-017-1903-8

[17] Double figure‐of‐eight reconstruction technique for chronic anterior sternoclavicular joint dislocation. Knee Surgery, Sports Traumatology, Arthroscopy. 2014. DOI: 10.1007/s00167-014-2979-4

[18] Sternoclavicular dislocation—reconstruction with semitendinosus tendon autograft: a case report. Knee Surgery, Sports Traumatology, Arthroscopy. 2008. DOI: 10.1007/s00167-008-0527-9

[19] Advances in the Management of Sternoclavicular Joint Injuries. Journal of Bone and Joint Surgery. 2026. DOI: 10.2106/jbjs.25.01025

[20] The prevalence of osteoarthritis of the sternoclavicular joint on computed tomography. Journal of Shoulder and Elbow Surgery. 2017. DOI: 10.1016/j.jse.2016.04.029

[21] MR imaging of the sternoclavicular joint following trauma. Clinical Imaging. 2004. DOI: 10.1016/s0899-7071(03)00096-2

[22] Outcomes and complications following graft reconstruction for anterior sternoclavicular joint instability. Knee Surgery, Sports Traumatology, Arthroscopy. 2015. DOI: 10.1007/s00167-015-3770-x

[23] Surgical stabilization of chronic traumatic anterior sternoclavicular joint instability based on magnetic resonance imaging diagnosis and structural anatomic magnetic resonance imaging findings. Journal of Shoulder and Elbow Surgery. 2026. DOI: 10.1016/j.jse.2025.04.018

[24] Resection Arthroplasty of the Sternoclavicular Joint. The Journal of Bone & Joint Surgery*. 1997. DOI: 10.2106/00004623-199703000-00011

[25] 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. Arthroscopy. 2025. DOI: 10.1016/j.arthro.2025.03.061

[26] Endopelvic migration of a sternoclavicular K-wire. Case report and review of literature. Orthopaedics & Traumatology: Surgery & Research. 2012. DOI: 10.1016/j.otsr.2011.09.015

[27] Experience with arthroscopic treatment of disorders in the sternoclavicular joint: A prospective series of 78 patients. Knee Surgery, Sports Traumatology, Arthroscopy. 2026. DOI: 10.1002/ksa.70298

[28] Arthroscopic Sternoclavicular Joint Resection Arthroplasty: A Technical Note and Illustrated Case Report. Arthroscopy Techniques. 2014. DOI: 10.1016/j.eats.2013.09.019

[29] Complications after sternoclavicular surgery. Journal of Shoulder and Elbow Surgery. 2021. DOI: 10.1016/j.jse.2020.09.015

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6. No endorsement. Nothing in this Public License constitutes or may be construed as permission to assert or imply that You are, or that Your use of the Licensed Material is, connected with, or sponsored, endorsed, or granted official status by, the Licensor or others designated to receive attribution as provided in Section 3(a)(1)(A)(i).

b. Other rights.

1. Moral rights, such as the right of integrity, are not licensed under this Public License, nor are publicity, privacy, and/or other similar personality rights; however, to the extent possible, the Licensor waives and/or agrees not to assert any such rights held by the Licensor to the limited extent necessary to allow You to exercise the Licensed Rights, but not otherwise.

2. Patent and trademark rights are not licensed under this Public License.

3. To the extent possible, the Licensor waives any right to collect royalties from You for the exercise of the Licensed Rights, whether directly or through a collecting society under any voluntary or waivable statutory or compulsory licensing scheme. In all other cases the Licensor expressly reserves any right to collect such royalties, including when the Licensed Material is used other than for NonCommercial purposes.

Section 3 -- License Conditions.

Your exercise of the Licensed Rights is expressly made subject to the following conditions.

a. Attribution.

1. If You Share the Licensed Material (including in modified form), You must:

a. retain the following if it is supplied by the Licensor with the Licensed Material:

i. identification of the creator(s) of the Licensed Material and any others designated to receive attribution, in any reasonable manner requested by the Licensor (including by pseudonym if designated);

ii. a copyright notice;

iii. a notice that refers to this Public License;

iv. a notice that refers to the disclaimer of warranties;

v. a URI or hyperlink to the Licensed Material to the extent reasonably practicable;

b. indicate if You modified the Licensed Material and retain an indication of any previous modifications; and

c. indicate the Licensed Material is licensed under this Public License, and include the text of, or the URI or hyperlink to, this Public License.

2. You may satisfy the conditions in Section 3(a)(1) in any reasonable manner based on the medium, means, and context in which You Share the Licensed Material. For example, it may be reasonable to satisfy the conditions by providing a URI or hyperlink to a resource that includes the required information.

3. If requested by the Licensor, You must remove any of the information required by Section 3(a)(1)(A) to the extent reasonably practicable.

4. If You Share Adapted Material You produce, the Adapter's License You apply must not prevent recipients of the Adapted Material from complying with this Public License.

Section 4 -- Sui Generis Database Rights.

Where the Licensed Rights include Sui Generis Database Rights that apply to Your use of the Licensed Material:

a. for the avoidance of doubt, Section 2(a)(1) grants You the right to extract, reuse, reproduce, and Share all or a substantial portion of the contents of the database for NonCommercial purposes only;

b. if You include all or a substantial portion of the database contents in a database in which You have Sui Generis Database Rights, then the database in which You have Sui Generis Database Rights (but not its individual contents) is Adapted Material; and

c. You must comply with the conditions in Section 3(a) if You Share all or a substantial portion of the contents of the database.

For the avoidance of doubt, this Section 4 supplements and does not replace Your obligations under this Public License where the Licensed Rights include other Copyright and Similar Rights.

Section 5 -- Disclaimer of Warranties and Limitation of Liability.

a. UNLESS OTHERWISE SEPARATELY UNDERTAKEN BY THE LICENSOR, TO THE EXTENT POSSIBLE, THE LICENSOR OFFERS THE LICENSED MATERIAL AS-IS AND AS-AVAILABLE, AND MAKES NO REPRESENTATIONS OR WARRANTIES OF ANY KIND CONCERNING THE LICENSED MATERIAL, WHETHER EXPRESS, IMPLIED, STATUTORY, OR OTHER. THIS INCLUDES, WITHOUT LIMITATION, WARRANTIES OF TITLE, MERCHANTABILITY, FITNESS FOR A PARTICULAR PURPOSE, NON-INFRINGEMENT, ABSENCE OF LATENT OR OTHER DEFECTS, ACCURACY, OR THE PRESENCE OR ABSENCE OF ERRORS, WHETHER OR NOT KNOWN OR DISCOVERABLE. WHERE DISCLAIMERS OF WARRANTIES ARE NOT ALLOWED IN FULL OR IN PART, THIS DISCLAIMER MAY NOT APPLY TO YOU.

b. TO THE EXTENT POSSIBLE, IN NO EVENT WILL THE LICENSOR BE LIABLE TO YOU ON ANY LEGAL THEORY (INCLUDING, WITHOUT LIMITATION, NEGLIGENCE) OR OTHERWISE FOR ANY DIRECT, SPECIAL, INDIRECT, INCIDENTAL, CONSEQUENTIAL, PUNITIVE, EXEMPLARY, OR OTHER LOSSES, COSTS, EXPENSES, OR DAMAGES ARISING OUT OF THIS PUBLIC LICENSE OR USE OF THE LICENSED MATERIAL, EVEN IF THE LICENSOR HAS BEEN ADVISED OF THE POSSIBILITY OF SUCH LOSSES, COSTS, EXPENSES, OR DAMAGES. WHERE A LIMITATION OF LIABILITY IS NOT ALLOWED IN FULL OR IN PART, THIS LIMITATION MAY NOT APPLY TO YOU.

c. The disclaimer of warranties and limitation of liability provided above shall be interpreted in a manner that, to the extent possible, most closely approximates an absolute disclaimer and waiver of all liability.

Section 6 -- Term and Termination.

a. This Public License applies for the term of the Copyright and Similar Rights licensed here. However, if You fail to comply with this Public License, then Your rights under this Public License terminate automatically.

b. Where Your right to use the Licensed Material has terminated under Section 6(a), it reinstates:

1. automatically as of the date the violation is cured, provided it is cured within 30 days of Your discovery of the violation; or

2. upon express reinstatement by the Licensor.

For the avoidance of doubt, this Section 6(b) does not affect any right the Licensor may have to seek remedies for Your violations of this Public License.

c. For the avoidance of doubt, the Licensor may also offer the Licensed Material under separate terms or conditions or stop distributing the Licensed Material at any time; however, doing so will not terminate this Public License.

d. Sections 1, 5, 6, 7, and 8 survive termination of this Public License.

Section 7 -- Other Terms and Conditions.

a. The Licensor shall not be bound by any additional or different terms or conditions communicated by You unless expressly agreed.

b. Any arrangements, understandings, or agreements regarding the Licensed Material not stated herein are separate from and independent of the terms and conditions of this Public License.

Section 8 -- Interpretation.

a. For the avoidance of doubt, this Public License does not, and shall not be interpreted to, reduce, limit, restrict, or impose conditions on any use of the Licensed Material that could lawfully be made without permission under this Public License.

b. To the extent possible, if any provision of this Public License is deemed unenforceable, it shall be automatically reformed to the minimum extent necessary to make it enforceable. If the provision cannot be reformed, it shall be severed from this Public License without affecting the enforceability of the remaining terms and conditions.

c. No term or condition of this Public License will be waived and no failure to comply consented to unless expressly agreed to by the Licensor.

d. Nothing in this Public License constitutes or may be interpreted as a limitation upon, or waiver of, any privileges and immunities that apply to the Licensor or You, including from the legal processes of any jurisdiction or authority.

Creative Commons is not a party to its public licenses. Notwithstanding, Creative Commons may elect to apply one of its public licenses to material it publishes and in those instances will be considered the “Licensor.” The text of the Creative Commons public licenses is dedicated to the public domain under the CC0 Public Domain Dedication. Except for the limited purpose of indicating that material is shared under a Creative Commons public license or as otherwise permitted by the Creative Commons policies published at creativecommons.org/policies, Creative Commons does not authorize the use of the trademark "Creative Commons" or any other trademark or logo of Creative Commons without its prior written consent including, without limitation, in connection with any unauthorized modifications to any of its public licenses or any other arrangements, understandings, or agreements concerning use of licensed material. For the avoidance of doubt, this paragraph does not form part of the public licenses.

Creative Commons may be contacted at creativecommons.org.