Osteochondral Allograft Transplantation for Treatment of Glenohumeral Instability

Department of Orthopedic Surgery, Temple University Hospital, Philadelphia, Pennsylvania 19140, USA.
Arthroscopy The Journal of Arthroscopic and Related Surgery (Impact Factor: 3.21). 09/2005; 21(8):1007. DOI: 10.1016/j.arthro.2005.04.005
Source: PubMed


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.

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    • "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. "
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    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.
    Full-text · Article · Jul 2014
    • "Even deeper and larger unipolar lesions have been successfully treated using osteochondral allograft, and Romeo et al. [18] have published a case report of ACI performed on a 16-year-old baseball player, which resulted in full, painless range of motion at 1-year follow-up. Osteochondral allograft has been shown to produce good results in the shoulder [19] [20], as well as in the ankle [21] [22], hip [23], and knee [24] [25] [26] [27] [28] [29] [30] [31] [32]. Non-arthroplasty options for biologic resurfacing include interpositional anterior shoulder capsule, autogenous fascia, Achilles tendon allograft [33], and lateral meniscal allograft [3] [34] [35], as well as off-label uses of xenograft and human-skin allograft [2] "
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    ABSTRACT: The treatment of large, bipolar osteochondral lesions of the glenohumeral joint in young, active patients is challenging. When conservative treatment fails to provide acceptable results, restorative and reconstructive options are often considered. Despite its success in relieving pain and restoring function, total shoulder arthroplasty has significant drawbacks for young patients. One surgical option is an all-arthroscopic osteochondral total shoulder resurfacing using fresh osteochondral allografts. By using an arthroscopic approach, damage to surrounding structures, including the subscapularis, is minimized, resulting in decreased morbidity and rehabilitation required after surgery when compared to standard total shoulder arthroplasty.
    No preview · Article · Mar 2014 · Seminars in Arthroplasty
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    • "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 [51]. "
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    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.
    Full-text · Article · Mar 2012
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