Fresh Osteochondral Allograft Transplantation for Focal Chondral Defect of the Humerus Associated With Anchor Arthropathy and Failed SLAP Repair

Abstract

Isolated, full-thickness articular cartilage lesions of the glenohumeral joint can cause pain, mechanical symptoms, and impaired function. Reports on operative management of these injuries with arthroscopic techniques, such as marrow stimulation, have shown improvement in patient symptoms. In cases where the subchondral bone is involved, osteochondral allograft (OCA) transplantation has shown positive results for contained, focal cartilage defects. The technique for OCA transplantation to treat Hill-Sachs lesions has been reported in detail, and there are multiple case series reporting on the outcomes of OCA used for this purpose. This Technical Note shows the application of OCA to treat a case of anchor arthropathy where a glenoid anchor placed during arthroscopic stabilization causes iatrogenic damage to the humeral head. This type of injury can result in cartilage lesions in uncommon locations, such as on the posterior humeral head. In this description, the technical pearls and pitfalls of managing difficult-to-access posterior humeral head lesions are presented along with the senior authors' general technique for OCA to treat focal lesions of the humeral head cartilage.

Use of Allografts in Orthopaedic Surgery: Safety, Procurement, Storage, and Outcomes

“…The humeral head and distal tibial allograft ordering process also involves size matching, although computed tomography (CT) imaging is recommended for this category of allografts. 22,52,57,63 To be used within 28 days of harvesting and optimally stored at 4 C, the surgeon should open the fresh allograft at the time of surgery and place it in a sterile, room-temperature solution of saline. 52,63 For distal tibial allografts, the most lateral aspect of the graft is harvested.…”

“…22,52,57,63 To be used within 28 days of harvesting and optimally stored at 4 C, the surgeon should open the fresh allograft at the time of surgery and place it in a sterile, room-temperature solution of saline. 52,63 For distal tibial allografts, the most lateral aspect of the graft is harvested. Riff et al 53 reported on midterm outcomes of fresh humeral head OCA transplantation in 18 patients.…”

Harvest, Transport, and Storage of Fresh Humeral Head Osteochondral Allograft: Step-by-Step Protocol

“…2,3,5 Besides, humeral head reconstruction with osteochondral allografts can improve shoulder range of movement, leading to better functional outcome scores and resulting in lower subsequent dislocation rates. 6,7 Most literature regarding allografts involves the use of articular cartilage specimens from the knee joint. However, this type of allograft does not seem suitable for reconstruction of the articular surface of the humeral head because of differences in both cartilage thickness and curvature.…”