Mid-Term outcomes following fresh-frozen humeral head osteochondral allograft reconstruction for reverse Hill Sachs lesion: a case series

Abstract

Background Locked posterior glenohumeral dislocations with a reverse Hill-Sachs impaction fracture involving less than 30% of the humeral head are most frequently treated with lesser tuberosity transfer into the defect, whereas those involving more than 50% undergo humeral head arthroplasty. Reconstruction of the defect with segmental femoral osteochondral allografts has been proposed to treat patients between these two ranges, but the medium−/long-term outcomes of this joint-preserving procedure are controversial. Methods Between 2001 and 2018, 12 consecutive patients with a unilateral locked posterior shoulder dislocation and an impaction fracture from 30 to 50% (mean 31% ± 1.32) of the humeral head were treated with segmental reconstruction of the defect with fresh-frozen humeral head osteochondral allografts. Patients were assessed clinically, radiographically and with computed tomography (CT) at a medium follow-up of 66 ± 50.25 months (range, 24–225). Results All twelve shoulders presented a slight limitation in anterior elevation (average, 166.6° ± 22.76). The mean active external rotation with the shoulder at 90° of abduction was 82.5° ± 6.61, and that with the arm held in stable adduction was 79.16 ± 18.80. The mean abduction was 156.25° ± 25.09. The mean Constant-Murley score (CS) was 82 ± 15.09 points (range, 40–97 points), and the mean ASES was 94 ± 8.49 points. The mean pre- and postoperatively Western Ontario Shoulder Instability index (WOSI) was 236.5 ± 227.9 and 11.20 ± 10.85, respectively. Development of osteoarthrosis (OA) was minimal. The average allograft resorption rate was 4% ± 2.4. There were no cases of failure (reoperation for any reason) in this series. Conclusion Segmental humeral head reconstruction with humeral head fresh-frozen osteochondral allografts provides good to excellent clinical results with low-grade OA and low allograft resorption in patients with locked posterior shoulder dislocation. Trial registration ClinicalTrials.gov PRS, ClinicalTrials.gov ID: NCT04823455. Registered 29 March 2021 - Retrospectively registered, https://register.clinicaltrials.gov/prs/app/action/SelectProtocol?sid=S000AU8P&selectaction=Edit&uid=U0004J36&ts=12&cx=6cykp8 Level of evidence Level IV, Case Series, Treatment Study.

Characteristics and Clinical Outcomes After Osteochondral Allograft Transplantation for Treating Articular Cartilage Defects: Systematic Review and Single-Arm Meta-analysis of Studies From 2001 to 2020

“…Patients with OCA for reverse Hill-Sachs lesions after acute locked posterior shoulder joint dislocation have significantly improved function, a low degree of osteoarthritis, and excellent clinical outcomes compared with preoperative results. 84,145 Riff et al 112 concluded that OCA was a feasible treatment option for humeral head osteochondral defects. Regarding OCA of the hip, Oladeji et al 100 (n = 10), Khanna et al 72 (n = 17), and Kosashvili et al 73 (n = 8) analyzed the clinical and radiological results of OCA in patients with sizable femoral head osteochondral defects and considered fresh OCA (OCA using a freshly preserved graft) a reasonable choice for young patients with hip cartilage defects.…”

The “BioHumi" Humeral Head Osteochondral Allograft Transplantation for Reverse Hill-Sachs Lesion of the Shoulder

“…The ability to harvest a larger, single graft is also beneficial because of the paucity of surface area available to harvest multiple grafts. Other techniques to address large humeral head defects have been described, 3 , 4 , 7 , 10 , 13 , 20 , 21 , 23 but the “free-hand” nature of these techniques can be difficult to replicate, and it is challenging to adequately restore the chondral surface and subchondral bone of the humeral head. The “Elliptical BioHumi” technique for OAT of the humeral head simplifies a technically demanding procedure with a reproducible method for addressing large, oblong osteochondral defects and potentially offers improved patient outcomes.…”

“… 1 , 2 Treatment options are often based on the size of the reverse Hill-Sachs lesion, and many authors have recommended shoulder arthroplasty for impaction fractures that involve more than 50% of the humeral head. 3 , 4 The management of a reverse Hill-Sachs lesion involving less than 50% of the humeral head in younger patients is more controversial, and joint preservation techniques are favored over arthroplasty ( Fig 1 ). Multiple surgical procedures have been described, ranging from transposition of the subscapularis tendon with or without the lesser tuberosity into the defect, disimpaction and bone grafting, rotational osteotomy of the proximal humerus, and reconstruction with an osteochondral allograft.…”

“…Multiple surgical procedures have been described, ranging from transposition of the subscapularis tendon with or without the lesser tuberosity into the defect, disimpaction and bone grafting, rotational osteotomy of the proximal humerus, and reconstruction with an osteochondral allograft. 4 , 5 , 6 , 7 , 8 , 9 , 10 Osteochondral allograft transplantation (OAT) was initially described for treatment of osteochondral lesions of the femoral condyle. 11 , 12 The success of OAT in the knee led Gerber and Lambert 13 to describe treatment of humeral head defects, resulting from chronic locked, posterior dislocations of the shoulder with OAT in 1996.…”

Management of Bone Loss in Posterior Glenohumeral Shoulder Instability

“…Martinez reported outcomes in 6 patients, with satisfactory outcomes in only 3 patients and advanced osteoarthritis or allograft collapse in the others 64 . In contrast, Marcheggiani Muccioli et al reported a low graft resorption rate with excellent patient-reported and clinical outcome measures in 12 of 12 patients at mean 5.5-year follow-up 65 .…”