Transplantation of a Tibial Osteochondral Allograft to Restore a Large Glenoid Osteochondral Defect

Abstract

Osteochondral disease of the glenoid is a well-known cause of shoulder pain and disability in young and active patients. The etiology can be multifactorial, and disease severity can exist across a wide spectrum. Symptoms can often interfere with athletic performance, job responsibilities, and activities of daily living. Although a number of cartilage restoration techniques exist for other joints, such as the hip, knee, ankle, and elbow, restorative options for glenoid osteochondral defects are currently limited. Given the success of osteochondral allograft transplantation in other joints, the authors hypothesized that osteochondral allograft transplantation may be a reasonable option in treating osteochondral disease of the glenoid if a suitable donor source could be identified. After performing the procedure in a cadaveric model, the authors found the articular geometry of the medial tibial plateau to closely resemble that of the glenoid articular surface. This graft option is advantageous because it is readily accessible from allograft tissue banks, whereas glenoid allografts are not currently available. After failure of extensive nonoperative treatment, a former multisport athlete underwent osteochondral allograft transplantation of a large glenoid defect with a medial tibial plateau osteochondral allograft. After 1 year of follow-up, the patient showed significant improvement in the subjective shoulder value (from 40% to 99%), QuickDASH score (from 36 to 2), and American Shoulder and Elbow Score (from 46 to 92). Ultimately, medial tibial plateau allograft was a viable option for treatment of an osteochondral glenoid defect in this patient, and additional study of this treatment strategy is warranted.

Articular Cartilage Defects of the Glenohumeral Joint: A Systematic Review of Treatment Options and Outcomes

“…Characteristics of the 14 studies meeting all inclusion criteria can be found in Table 1 . 1-6,17-24 There were 6 retrospective case series, 7 case reports, and 1 prospective case series. This resulted in a total of 100 shoulders in 98 patients.…”

“…The etiology of cartilage injury within the glenohumeral joint can include previous surgery, trauma, osteochondritis dissecans, infection, avascular necrosis, inflammatory arthritis, glenohumeral joint instability, rotator cuff arthropathy, osteoarthritis, and chondrolysis. 1 Patients with glenohumeral cartilage or osteochondral defects may present with a variety of symptoms, including generalized achiness exacerbated with activity, progressive pain to the point of limiting sport activities, constant deep shoulder pain, sharp pain following an acute injury, or progressive crepitation associated with increasing pain. 1-6…”

“…1 Patients with glenohumeral cartilage or osteochondral defects may present with a variety of symptoms, including generalized achiness exacerbated with activity, progressive pain to the point of limiting sport activities, constant deep shoulder pain, sharp pain following an acute injury, or progressive crepitation associated with increasing pain. 1-6…”

Assessment of Safe Cartilage Harvesting Quantity in the Shoulder: A Cadaveric Study

“…According to the literature, the mean glenoid defect size ranges from 1.12 to 2.73 cm 2 , whereas the mean humeral defect size ranges from 4.22 to 6.00 cm 2 (Table 2). 3,[13][14][15][16] The mean articular cartilage depth of the humerus has been reported to be 1.24 mm, ranging from approximately 1.3 mm centrally and thinning to less than 1 mm along the periphery, and the mean depth of the glenoid fossa has been reported to be 1.88 mm. 17 Regeneration of lost cartilage has been the ultimate goal for treatment of articular cartilage defects of the glenohumeral joint.…”

Biomimetic biphasic scaffolds for osteochondral defect repair

“…Debridement and bone marrow stimulation may not provide a satisfied long-term prognosis, especially in young active patients [ 12 ]. Although osteochondral grafts demonstrate satisfactory outcomes, the allografts face a limited application ascribed to immune rejection and the risk of disease transmission [ 13 , 14 ], and the autografts will cause additional physical trauma [ 15 , 16 ]. Therefore, there need alternative therapies for osteochondral defects urgently.…”