Treatment of osteochondral injuries of the humeral head using fresh osteochondral allograft transplantation

Abstract

BackgroundLarge osteochondral lesions of the humeral head can result from locked posterior dislocations, avascular necrosis, and osteochondritis dissecans. Fresh osteochondral allograft (OCA) transplantation is a treatment option for young patients with focal osteochondral defects of the humeral head. The purpose of this case series was to assess graft survivorship, subjective patient-reported outcomes (PROMs), and satisfaction among seven patients who underwent OCA transplantation of the humeral head. MethodsWe identified seven patients who underwent humeral head OCA transplantation between 2008 and 2017. A custom questionnaire for patient reported outcome measures including ASES, QuickDASH, Likert satisfaction, and reoperations was mailed to each patient. Clinical failure was defined as further surgery that involved removal of the allograft. ResultsMedian follow-up duration was 10 years (range, 4.6 to 13.5 years) with a median age of 21.6 years (range, 18.5 to 43.5 years). Most patients (86%) reported improved function and reduced pain. At final follow-up, 71% of patients reported ongoing problems with their shoulder including pain, stiffness, clicking/grinding, limited range of motion, and instability. Return to recreational activities was high at 86% but 43% expressed limitations with activity due to their shoulder. Overall satisfaction was high at 71% with mean ASES and QuickDASH scores at 62.4 and 29.2 respectively. Reoperation after OCA occurred in one patient (14%). ConclusionsAmong this case series of seven patients who underwent OCA transplantation of the humeral head, patient satisfaction was high at 10 year follow-up and most returned to recreational activity although most also had persistent shoulder symptoms.