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Feasibility of an Osteochondral Allograft for Biologic Glenoid Resurfacing

Posted on: July 28th, 2016 by Our Team

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Shoulder pathology such as isolated chondral defects, chondrolysis, osteoarthritis, post-traumatic arthritis, and instability arthropathy can cause shoulder pain and disability in young active patients. Glenoid cartilage loss is discovered in 5% to 17% of diagnostic arthroscopies, although in many cases the contribution of the glenoid lesion to patient symptomatology is unclear. In the young active patient, surgical management of symptomatic glenoid chondral lesions is controversial, with outcomes poorly reported in the literature. Management may depend on multiple factors including the presence or absence of bipolar disease, patient age, activity level, expectations, and concomitant shoulder pathology.

For patients unresponsive to nonoperative management including activity modification, physical therapy, nonsteroidal anti-inflammatory medications, and corticosteroid injections, surgical treatment can be considered. Although total shoulder arthroplasty has predictable outcomes in older patients, younger patients have up to a 38% incidence of glenoid component failure within 10 years of follow-up. Non-arthroplasty options for young active patients are limited to debridement, capsular release, microfracture, ream and run, autologous chondrocyte implantation, and osteoarticular grafting procedures. Biologic glenoid resurfacing using anterior capsule, autogenous fascia lata, and lateral meniscal allograft and Achilles tendon allograft can also be considered.

Osteochondral allograft transplantation to the glenoid may be a viable alternative to current treatment methods. Though successful in other joints, press-fit osteochondral allografting of the glenoid has been described only in a few cases. Concern exists as to whether adequate depth to achieve a stable press fit may result in cortical blowout during reaming. The purpose of this study was to use 3-dimensional (3D) computed tomography (CT) modeling of cadaveric glenoids to determine the maximum graft diameter possible based on a given reamer depth. We elected to study depths of 4, 6, and 8 mm based on a recent biomechanical study that showed glenoid osteochondral allograft press-fit stability with a reaming depth of 4 mm. We hypothesized that as the depth of glenoid reaming increased, the corresponding osteochondral allograft diameter size would become significantly smaller.

Full Article: Feasibility of an osteochondral allograft for biologic glenoid resurfacing


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