The intimate contact between articular surfaces of the humeral head and glenoid labrum contribute to glenohumeral stability. When the articular surface area of these 2 surfaces is decreased, as with the presence of a bony Bankart lesion or an engaging Hill-Sachs lesion, the shoulder is more prone to dislocation. Although osteochondral allograft transplantation has become widely popular for the treatment of osteochondral defects of the knee, it is less used for treating bony defects of the humeral head. We present a case in which a 16-year-old male athlete with multiple anterior shoulder dislocations underwent arthroscopic repair of a Bankart lesion. His arthroscopic repair ultimately failed and on subsequent magnetic resonance imaging he was found to have a large, engaging Hill-Sachs defect. He underwent arthroscopic osteochondral allograft transplantation to correct the humeral head bony deformity. As of the 1-year follow-up, the patient has had no recurrences and had returned to his normal level of activity.
"This procedure attempts to fill larger defects with both a structural and osteoconductive material in an attempt to avoid prosthetic replacement. Specific indications mainly restrict this procedure to younger patients with larger sized defects that do not have a significant degree of osteopenia or degenerative joint disease [25, 41]. After an appropriate preoperative workup that includes a CT scan to delineate humeral head bony architecture and the characteristics of the lesion, a sized matched fresh-frozen humeral or femoral head is obtained and used to graft into the identified defect. "
[Show abstract][Hide abstract] ABSTRACT: Recurrent shoulder instability and resultant glenoid and humeral head bone loss are not infrequently encountered in the population today, specifically in young, athletic patients. This review on the management of bone loss in recurrent glenohumeral instability discusses the relevant shoulder anatomy that provides stability to the shoulder joint, relevant history and physical examination findings pertinent to recurrent shoulder instability, and the proper radiological imaging choices in its workup. Operative treatments that can be used to treat both glenoid and humeral head bone loss are outlined. These include coracoid transfer procedures and allograft/autograft reconstruction at the glenoid, as well as humeral head disimpaction/humeroplasty, remplissage, humeral osseous allograft reconstruction, rotational osteotomy, partial humeral head arthroplasty, and hemiarthroplasty on the humeral side. Clinical outcomes studies reporting general results of these techniques are highlighted.
"As a restorative technique, allograft transfer has proven efficacious in other joints [46–48] but their application to the glenohumeral joint is relatively uncommon. The most frequent use of allograft in the glenohumeral joint is for the treatment of engaging Hill-Sachs lesions and bony deficits resulting from glenohumeral instability following tumor resections [49, 50]. Recently Krishnan et al. published promising early results in 4 patients, mean age 47, of an all-arthroscopic technique for osteochondral allograft resurfacing of both the glenoid and humeral articular surface . "
[Show abstract][Hide abstract] ABSTRACT: The management of osteoarthritis of the shoulder in young, active patients is a challenge, and the optimal treatment has yet to be completely established. Many of these patients wish to maintain a high level of activity, and arthroplasty may not be a practical treatment option. It is these patients who may be excellent candidates for joint-preservation procedures in an effort to avoid or delay joint replacement. Several palliative and restorative techniques are currently optional. Joint debridement has shown good results and a combination of arthroscopic debridement with a capsular release, humeral osteoplasty, and transcapsular axillary nerve decompression seems promising when humeral osteophytes are present. Currently, microfracture seems the most studied reparative treatment modality available. Other techniques, such as autologous chondrocyte implantation and osteochondral transfers, have reportedly shown potential but are currently mainly still investigational procedures. This paper gives an overview of the currently available joint preserving surgical techniques for glenohumeral osteoarthritis.
"The inner table of the iliac crest is concave and fits well with the native glenoid curvature.12,13,38 A glenoid osteochondral allograft provides an articular surface along with the added bony stability.6,29,37 The inferior surface of a distal tibia allograft can provide a good anatomic articular surface and is much easier to obtain.29 "
[Show abstract][Hide abstract] ABSTRACT: Osseous injury to the glenoid is increasingly being recognized as one of the most important aspects in the successful management of recurrent shoulder instability. Proper early recognition of glenoid bone injury in the setting of recurrent instability will lead to successful nonoperative and operative decision making, particularly in the athletic patient.
We conducted a MEDLINE search on shoulder instability from 2000 to 2010. The emphasis was placed on patient-oriented Level 1 literature from 2000 to 2010.
After a traumatic anterior dislocation of the shoulder, the most common structural injury is an avulsion of the anteroinferior capsulolabrum, which is also known as a Bankart lesion. If this specific injury is accompanied by an associated fracture in the glenoid rim, the term bony Bankart lesion is more applicable. With diminished articular constraints, the glenohumeral joint is subject to recurrent instability, thereby potentiating the bony injury cycle. Additionally, patients with osseous defects usually complain of instability within the midranges of motion, or they recall a progression of instability. If glenoid bone loss is present, the humeral head often easily subluxates over the glenoid in the midranges of abduction (30°-90°) and lower levels of external rotation. Imaging workup should begin with plain radiographs, but advanced imaging should be obtained if there is any suspicion of bone loss. Treatment includes both nonoperative and operative interventions.
Estimation of the amount of glenoid bone loss and the failure of nonoperative care is essential for guiding management, patient expectations, and surgical decision making.
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