Humeral Head Reconstruction with Osteochondral Allograft Transplantation
Purpose: To review the clinical evidence associated with the use of osteochondral allograft transplants for large defects of the humeral head.
- Size-matched, fresh and fresh-frozen humeral or femoral head allograft plugs were press fit into defects over four studies and in 8 single-case reports
- In 35 patients, significant improvements seen in forward flexion at 6 months, forward flexion at 12 months and external rotation at 12 months
- American Shoulder and Elbow Surgeon (ASES) scores improved by 14 points
- 100% of patients were able to return to work
- Radiographic findings at final follow-up showed allograft necrosis in 8.7%, resorption in 36.2% and glenohumeral arthritic changes in 35.7% of cases
- Risks of the procedure include a 20-30% complication rate and a 26% re-operation rate
- The use of fresh allograft may result in less resorption and necrosis in comparison to fresh-frozen tissues
Take Away: Despite high complication and re-operation rates, this procedure has shown significant improvements in shoulder motion, ASES scores, patient satisfaction and return to work rates. It should be considered for large symptomatic humeral defects.
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Study Design: Systematic Review, Level of Evidence: 3
Authors: Bryan M. Saltzmann, MD, Jonathan C. Riboh, MD, Brian J. Cole, MD, MBA, Adam Yanke, MD
Institution: Rush University Medical Center, Chicago, Illinois