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.bioventusglobal.com/

http://www.sonosite.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 marrow1

• Cells are abundant (unlikely to decrease with age, as

bone marrow-derived cells)

• Less risk associated with autologous therapies
• 1Hass, 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

Lipogems

WASTE (blood and oil) STERILE SALINE (1000 mL bag) Initial adipose cluster reduction Final adipose cluster reduction

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!!