Topographic Analysis of the Glenoid and Proximal Medial Tibial Articular Surfaces – A Search for the Ideal Match for Glenoid Resurfacing
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The most widely accepted treatment for end-stage primary glenohumeral arthritis is total shoulder arthroplasty (TSA) because of its ability to provide predictable pain relief and improved function. This is particularly the case in elderly and sedentary patients. In young, active patients with higher functional demands, however, TSA for glenohumeral arthritis presents a treatment dilemma. Concerns for component loosening that necessitate revision at an early age, high patient expectations, and bone loss and/or soft tissue contracture from prior surgery can all make deci- sion making difficult for this patient population.
Proposed treatment alternatives to TSA for such patients include arthroscopic capsular release, partial or complete synovectomy, microfracture, and nonbiological resurfacing hemiarthroplasty. In an attempt to preserve glenoid bone stock, biological soft tissue resurfacing in the form of Achilles allograft, lateral meniscus allograft, and tissue matrices has been introduced. Limited efficacy due to the failure to restore normal anatomic features and provide adequate pain relief, however, has led to unsatisfactory outcomes. This is of particular difficulty in situations in which there is glenoid bone loss. In an attempt to restore glenoid bone stock, osteochondral allografting of the glenoid has been introduced as an alternative option. Its effective use in shoulder instability and revision arthroplasty has been described. Because of a current lack of available glenoid osteochondral allografts, knowledge of sites that provide an anatomic match to the glenoid articular concavity can help advance this technique when used for the purposes of articular-sided resurfacing.
To our knowledge, there are no data demonstrating an anatomic site that provides an articular surface match to the glenoid for the purposes of total articular osteochondral allograft resurfacing. We hypothesized that the medial tibial plateau will provide an ideal site for glenoid osteochondral allograft resurfacing because of its concave shape and anatomic similarity to the glenoid articular surface. The purpose of this study was 3-fold: (1) to quantify the articular surface topography of the glenoid and medial tibial plateau, (2) to reconstruct 3-dimensional models to determine whether the medial tibial articular surface provides a topographic match to the articular surface of the glenoid, and (3) to compare the anterior and posterior aspects of the medial tibial articular surface to determine whether one zone has a more congruent topographic match.