Sternoclavicular Injury Lets Treat it with Fat!! Claude T. Moorman, - PowerPoint PPT Presentation

Sternoclavicular Injury Let’s Treat it with Fat!! Claude T. Moorman, III, MD Orthopaedic Surgery Duke University Medical Center

Disclosures l Fellowship Support ฀ Breg ฀ DJO ฀ Arthrex ฀ Mitek ฀ Smith Nephew l Consultant ฀ Lipogems ฀ Enlyten ฀ PrivIT ฀ SMV

Sternoclavicular Injury ฀ Background ฀ Anterior Instability ฀ Acute ฀ Chronic ฀ Posterior Instability ฀ Arthrosis ฀ Where to use Lipogems!

Sternoclavicular injuries • Anatomy – Capsular ligament (anterior and superior sternoclavicular ligament) – Intra-articular disk ligament – Extra-articular costoclavicular ligament (rhomboid ligament) – Interclavicular ligament.

Sternoclavicular Injury Treatment Options ฀ Observation ฀ Closed/Open Reduction ฀ Open Stabilization ฀ Resection Arthroplasty ฀ Regenerative Medicine

Sternoclavicular injuries • Mechanism – Indirect mechanism • If shoulder rolls backward, anterior dislocation results • DeLee & Drez, 2003

Sternoclavicular injuries • Treatment – Posterior dislocation • N=13 patients • F/U = 22 months • non-absorbable suture • Results: 100% success • No pain No clinical instability. Waters JPO 2003

Sternoclavicular injuries • Mechanism – Indirect mechanism • If shoulder rolls forward, posterior dislocation results DeLee & Drez, 2003

Sternoclavicular injuries • Imaging – Radiographs • 40 degree cephalic tilt view, aka “serendipity” view – CT scan most effective Yang Am J Orthop 1995

Ultrasound Machines http://www.sonosite.com http://www.bioventusglobal.com/

Sternoclavicular Joint Injection

Adiprep

Lipogems

MSCs!! L e ve l 7 E xpe r t Opinio n! • Arno ld K a pla n, PhD • Me se nc hyma l Ste m Ce lls (Me so de rm) • E mb ryo nic • Pluripo te nt • Dire c te d • Adult • Adipo se / Ma rro w • Mo re dire c te d • E xo so me s

Benefits of Adipose Tissue • Relatively easy to obtain with minimally invasive ha rve st • High concentrations of regenerative cells found in adipose tissue (Kaplan, Guilak, Futrell) (Order of Magnitude—10X) • From 1g of adipose tissue 5000 stem cells can be isolated, which is 500 times more cells than from an equivalent amount of bone marrow 1 • Cells are abundant (unlikely to decrease with age, as bone marrow-derived cells) • Less risk associated with autologous therapies • 1 Hass, Ralf, Cornelia Kasper, Stefanie Böhm, and Roland Jacobs. "Different Populations and Sources of Human Mesenchymal Stem Cells (MSC): A Comparison of Adult and Neonatal Tissue-derived MSC." Cell Commun Signal Cell Communication and Signaling 9.1 (2011): 12.

Ge ntle shaking of tissue • Sta inle ss ste e l b a ll b e a ring s he lp to b re a k up tissue b y me c ha nic a l a g ita tio n, wa shing a wa y ma ture a dipo c yte s • T he y a lso a c t to e mulsify the tissue to re mo ve o il a nd b lo o d re sidue s fro m tissue

The system: wash, rinse, resize STERILE Lipogems SALINE (1000 Initial adipose mL bag) cluster reduction Final adipose cluster reduction WASTE (blood and oil)

Sternoclavicular Joint Injection

Sternoclavicular Injury ฀ Anterior Instability ฀ Acute-Reduction ฀ Recurrent ฀ Observation ฀ Stabilization ฀ Posterior Instability ฀ Closed vs Open reduction

Sternoclavicular Injury ฀ Arthrosis ฀ Surgery Not Predictable ฀ Observation Not Rewarding ฀ Consider some Fat!!