Midterm results of osteochondral allograft transplantation to the humeral head.
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.


CONCLUSIONS
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.
Department of Orthopaedics, Rush University Medical Center, Chicago, IL, USA. Electronic address: ariff8@gmail.com.
Andrew J
AJ
Riff
Department of Orthopaedics, Rush University Medical Center, Chicago, IL, USA.
Adam B
AB
Yanke
Department of Orthopaedics, Royal University Hospital, University of Saskatchewan, Saskatoon, SK, Canada.
Jason J
JJ
Shin
Department of Orthopaedics, Rush University Medical Center, Chicago, IL, USA.
Anthony A
AA
Romeo
Department of Orthopaedics, Rush University Medical Center, Chicago, IL, USA.
Brian J
BJ
Cole
D000293:Adolescent; D000328:Adult; D000072228:Arthroplasty, Replacement, Shoulder; D016025:Bone Transplantation; D002357:Cartilage Diseases / Q000601:surgery*; D002358:Cartilage, Articular / Q000601:surgery*; D005260:Female; D006801:Humans; D058430:Humeral Head / Q000601:surgery*; D008297:Male; D010147:Pain Measurement; D011859:Radiography; D012189:Retrospective Studies; D012785:Shoulder Joint; D016896:Treatment Outcome; D055815:Young Adult
cartilage restoration; chondrolysis; humeral head; osteochondral allograft; osteochondral defect; shoulder