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Midterm results of osteochondral allograft transplantation to the humeral head.
J Shoulder Elbow Surg. 2017 Jul; 26(7):e207-e215.JS

Abstract

BACKGROUND

This study evaluated clinical outcomes of osteochondral allograft (OCA) transplantation for humeral head osteochondral defects. We hypothesized that patients with isolated humeral head disease would achieve favorable results and that patients with bipolar disease would experience inferior outcomes.

METHODS

We identified patients who underwent humeral head OCA transplantation. Subjective questionnaire data were obtained preoperatively and at a minimum of 2 years postoperatively. Radiographs were evaluated for graft incorporation. Failure was defined by conversion to shoulder arthroplasty, American Shoulder and Elbow Surgeons score <50, or dissatisfaction with the surgical result.

RESULTS

Twenty patients (65% male) met inclusion criteria. Patients were an average age of 24.8 ± 8.1 years. Eleven patients underwent concomitant glenoid surgery (microfracture or meniscal allograft resurfacing). Follow-up was available for 18 patients (90%) at mean of 67 months. All grafts incorporated except 2. Four patients underwent shoulder arthroplasty at mean of 25 months postoperatively (all after pain pump chondrolysis). Eleven of the 20 patients were satisfied (all dissatisfied patients underwent glenoid surgery). Significant improvements (P < .001) were seen for the visual analog scale (from 6.1 to 1.5), Simple Shoulder Test (from 32 to 73), American Shoulder and Elbow Surgeons score (from 39 to 76), and the physical component of the 12-Item Short Form Survey (from 38 to 48). Pain pump patients who did not progress to arthroplasty experienced inferior satisfaction (40% vs. 87.5%, P = .04) and a trend toward inferior outcomes compared with the rest of the cohort.

CONCLUSION

OCA transplantation is a viable option for young patients with isolated humeral chondral injury. Patients with bipolar disease or a history of intra-articular pain pump have increased failure and decreased subjective outcomes.

Authors+Show Affiliations

Department of Orthopaedics, Rush University Medical Center, Chicago, IL, USA. Electronic address: ariff8@gmail.com.Department of Orthopaedics, Rush University Medical Center, Chicago, IL, USA.Department of Orthopaedics, Royal University Hospital, University of Saskatchewan, Saskatoon, SK, Canada.Department of Orthopaedics, Rush University Medical Center, Chicago, IL, USA.Department of Orthopaedics, Rush University Medical Center, Chicago, IL, USA.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

28162881

Citation

Riff, Andrew J., et al. "Midterm Results of Osteochondral Allograft Transplantation to the Humeral Head." Journal of Shoulder and Elbow Surgery, vol. 26, no. 7, 2017, pp. e207-e215.
Riff AJ, Yanke AB, Shin JJ, et al. Midterm results of osteochondral allograft transplantation to the humeral head. J Shoulder Elbow Surg. 2017;26(7):e207-e215.
Riff, A. J., Yanke, A. B., Shin, J. J., Romeo, A. A., & Cole, B. J. (2017). Midterm results of osteochondral allograft transplantation to the humeral head. Journal of Shoulder and Elbow Surgery, 26(7), e207-e215. https://doi.org/10.1016/j.jse.2016.11.053
Riff AJ, et al. Midterm Results of Osteochondral Allograft Transplantation to the Humeral Head. J Shoulder Elbow Surg. 2017;26(7):e207-e215. PubMed PMID: 28162881.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Midterm results of osteochondral allograft transplantation to the humeral head. AU - Riff,Andrew J, AU - Yanke,Adam B, AU - Shin,Jason J, AU - Romeo,Anthony A, AU - Cole,Brian J, Y1 - 2017/02/02/ PY - 2016/07/29/received PY - 2016/11/20/revised PY - 2016/11/25/accepted PY - 2017/2/7/pubmed PY - 2018/3/6/medline PY - 2017/2/7/entrez KW - cartilage restoration KW - chondrolysis KW - humeral head KW - osteochondral allograft KW - osteochondral defect KW - shoulder SP - e207 EP - e215 JF - Journal of shoulder and elbow surgery JO - J Shoulder Elbow Surg VL - 26 IS - 7 N2 - BACKGROUND: This study evaluated clinical outcomes of osteochondral allograft (OCA) transplantation for humeral head osteochondral defects. We hypothesized that patients with isolated humeral head disease would achieve favorable results and that patients with bipolar disease would experience inferior outcomes. METHODS: We identified patients who underwent humeral head OCA transplantation. Subjective questionnaire data were obtained preoperatively and at a minimum of 2 years postoperatively. Radiographs were evaluated for graft incorporation. Failure was defined by conversion to shoulder arthroplasty, American Shoulder and Elbow Surgeons score <50, or dissatisfaction with the surgical result. RESULTS: Twenty patients (65% male) met inclusion criteria. Patients were an average age of 24.8 ± 8.1 years. Eleven patients underwent concomitant glenoid surgery (microfracture or meniscal allograft resurfacing). Follow-up was available for 18 patients (90%) at mean of 67 months. All grafts incorporated except 2. Four patients underwent shoulder arthroplasty at mean of 25 months postoperatively (all after pain pump chondrolysis). Eleven of the 20 patients were satisfied (all dissatisfied patients underwent glenoid surgery). Significant improvements (P < .001) were seen for the visual analog scale (from 6.1 to 1.5), Simple Shoulder Test (from 32 to 73), American Shoulder and Elbow Surgeons score (from 39 to 76), and the physical component of the 12-Item Short Form Survey (from 38 to 48). Pain pump patients who did not progress to arthroplasty experienced inferior satisfaction (40% vs. 87.5%, P = .04) and a trend toward inferior outcomes compared with the rest of the cohort. CONCLUSION: OCA transplantation is a viable option for young patients with isolated humeral chondral injury. Patients with bipolar disease or a history of intra-articular pain pump have increased failure and decreased subjective outcomes. SN - 1532-6500 UR - https://www.unboundmedicine.com/medline/citation/28162881/Midterm_results_of_osteochondral_allograft_transplantation_to_the_humeral_head_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1058-2746(16)30644-9 DB - PRIME DP - Unbound Medicine ER -