From the Research
The ideal age for a sternoclavicular (SC) joint graft is typically between 15 and 40 years old, as this range allows for optimal tissue healing capacity, bone quality, and balance between skeletal maturity and age-related degenerative changes. This age range is supported by the study by 1, which demonstrated successful outcomes in patients with temporomandibular joint ankylosis who underwent SC joint graft reconstruction. The study found that the mean post-operative mouth opening achieved was 28.9mm, with significant improvements in laterotrusive and protrusive movements, and a 6.2mm increase in ramus height.
The procedure can be performed successfully in patients outside this range, depending on individual circumstances. For pediatric patients under 15, conservative management is often preferred initially, as their growth plates may still be open, potentially complicating graft integration. In patients over 40, the procedure remains viable, but may have slightly longer recovery times due to decreased tissue healing capacity with age. The timing of the procedure should be based on symptom severity, functional limitations, and failure of conservative treatments, rather than age alone.
Some studies, such as 2, have reported successful outcomes in older patients, with a median age of 44 years, and a range of 15-79 years. However, these studies are not directly comparable, and the optimal age range for SC joint grafting remains a topic of debate. The study by 3 introduced a novel technique for harvesting the sternoclavicular graft, which may reduce donor site morbidity and improve patient comfort.
Key considerations for determining the ideal age for SC joint grafting include:
- Optimal tissue healing capacity
- Bone quality
- Balance between skeletal maturity and age-related degenerative changes
- Symptom severity and functional limitations
- Failure of conservative treatments
Overall, the decision to perform an SC joint graft should be based on individual patient needs and circumstances, rather than a strict age cutoff. The most recent and highest quality study, 1, supports the use of SC joint grafting in patients between 15 and 40 years old, with careful consideration of individual factors and circumstances.