Long-term outcomes after osteochondral allograft transplantation to the humeral head.

Abstract

Long-term outcomes of osteochondral allograft (OCA) transplantation to the humeral head have been sparsely reported in the literature. To evaluate outcomes and survivorship of OCA transplantation to the humeral head in patients with osteochondral defects at a minimum of 10years of follow-up. A registry of patients who underwent humeral head OCA transplantation between 2004 and 2012 was reviewed. Patients completed pre and postoperative surveys including the American Shoulder and Elbow Surgeons score, Simple Shoulder Test, Short Form 12 (SF-12), and the visual analog scale. Failure was defined by conversion to shoulder arthroplasty. Fifteen of 21 (71%) patients with a minimum of ten year of follow-up (mean: 14.2±2.40) were identified. Mean patient age was 26.1±8.8years at the time of transplantation and eight (53%) patients were male. Surgery was performed on the dominant shoulder in 11 of the 15 (73%) cases. The use of local anesthetic delivered via an intra-articular pain pump was the most often reported underlying etiology of chondral injury (n=9; 60%). Eight (53%) patients were treated with an allograft plug, while seven (47%) patients were treated with a mushroom cap allograft. At final follow-up, mean American Shoulder and Elbow Surgeons (49.9 to 81.1; P=.048) and Simple Shoulder Test (43.1 to 83.3; P=.010) significantly improved compared to baseline. Changes in mean SF-12 physical (41.4 to 48.1; P=.354), SF-12 mental (57.5 to 51.8; P=.354), and visual analog scale (4.0 to 2.8; P=.618) did not reach statistical significance. Eight (53%) patients required conversion to shoulder arthroplasty at an average of 4.8±4.7years (range: 0.6-13.2). Kaplan-Meier graft survival probabilities were 60% at 10years and 41% at 15years. OCA transplantation to the humeral head can result in acceptable long-term function for patients with osteochondral defects. While patient-reported outcomes metrics were generally improved compared to baseline, OCA graft survival probabilities diminished with time. The findings from this study can be used to counsel future patients with significant glenohumeral cartilage injuries and set expectations about the potential for further surgery.