Sternoclavicular Joint Reconstruction for Chronic Anterior Instability: An Updated Sternal Docking Technique With a Modified Girth Hitch

Abstract Chronic anterior sternoclavicular joint instability can be functionally limiting in active patient populations, requiring reconstruction in patients who fail to achieve acceptable outcomes with nonoperative treatment. A variety of reconstruction techniques have been described including allograft or autograft figure‐of‐8 reconstruction, intramedullary graft reconstruction, synthetic suture‐based reconstruction, and tenodesis of the sternocleidomastoid or subclavius. Overall, considerable variability in techniques and outcomes exists in the current literature. Although figure‐of‐8 graft reconstruction techniques have been considered the historical gold standard for chronic sternoclavicular joint instability, it is technically demanding and carries an increased risk for mediastinal structures because of bicortical drilling. Therefore, sternal docking reconstructive techniques have gained popularity with robust, unicortical sockets and more controlled tunnel depth/placement. This technical note describes a sternal docking reconstruction technique for chronic anterior sternoclavicular joint instability using a semitendinosus allograft with a modified girth hitch for the allograft in the medial clavicle tunnel and 2 unicortical sternal sockets, allowing anatomic graft placement while minimizing posterior dissection and risk of tunnel convergence, posterior cortical fracture, and/or injury to mediastinal structures.