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Ganokroj P, Adriani M, Whalen RJ, Provencher MT. Treatment of Shoulder Cartilage Defects in Athletes. Sports Med Arthrosc Rev 2024; 32:87-94. [PMID: 38978202 DOI: 10.1097/jsa.0000000000000404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/10/2024]
Abstract
Articular cartilage defects in the glenohumeral joint may be found in laborers, the elderly, and young athletes, among others. Various factors can contribute to cartilage damage, including prior surgery, trauma, avascular necrosis, inflammatory arthritis, joint instability, and osteoarthritis. There is a wide variety of treatment options, from conservative treatment, injections, and surgical options, including arthroscopic debridement, microfracture, osteochondral autograft transfer, osteochondral graft transplantation, autologous chondrocyte implantation, and the newly emerging techniques such as biologic augmentation. There is a challenge to determine the optimal treatment options, especially for young athletes, due to limited outcomes in the literature. However, there are many options which are viable to address osteochondral defects of the glenohumeral joint.
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Affiliation(s)
- Phob Ganokroj
- Steadman Philippon Research Institute, Vail, CO
- Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok
| | - Marco Adriani
- Steadman Philippon Research Institute, Vail, CO
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
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Ganokroj P, Garcia AR, Hollenbeck JF, Fossum BW, Peebles AM, Whalen RJ, Chang PS, Provencher MT. Utility of Talus Osteochondral Allograft Augmentation for Varying Hill-Sachs Lesion Sizes: A Cadaveric Study. Orthop J Sports Med 2023; 11:23259671231203285. [PMID: 37868214 PMCID: PMC10585998 DOI: 10.1177/23259671231203285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 05/19/2023] [Indexed: 10/24/2023] Open
Abstract
Background Humeral head reconstruction with fresh osteochondral allografts (OCA) serves as a potential treatment option for anatomic reconstruction. More specifically, talus OCA is a promising graft source because of its high congruency with a dense cartilaginous surface. Purpose To analyze the surface geometry of the talus OCA plug augmentation for the management of shoulder instability with varying sizes of Hill-Sachs lesions (HSLs). Study Design Controlled laboratory study. Methods Seven fresh-frozen cadaveric shoulders were tested in this study. The humeral heads were analyzed using actual patients' computed tomography scans. Surface laser scan analysis was performed on 7 testing states: (1) native state; (2) small HSL; (3) talus OCA augmentation for small HSL; (4) medium HSL; (5) talus OCA augmentation for medium HSL; (6) large HSL; and (7) talus OCA augmentation for large HSL. OCA plugs were harvested from the talus allograft and placed in the most medial and superior aspect of each HSL lesion. Surface congruency was calculated as the mean absolute error and the root mean squared error in the distance. A 1-way repeated-measures analysis of variance was performed to evaluate the effects of the difference in the HSL size and associated talus OCA plugs on surface congruency and the HSL surface area. Results The surface area analysis of the humeral head with the large (1469 ± 75 mm2), medium (1391 ± 81 mm2), and small (1230 ± 54 mm2) HSLs exhibited significantly higher surface areas than the native state (1007 ± 88 mm2; P < .001 for all sizes). The native state exhibited significantly lower surface areas as compared with after talus OCA augmentation for large HSLs (1235 ± 63 mm2; P < .001) but not for small or medium HSLs. Talus OCA augmentation yielded improved surface areas and congruency after treatment in small, medium, and large HSLs (P < .001). Conclusion Talus OCA plug augmentation restored surface area and congruency across all tested HSLs, and the surface area was best improved with the most common HSLs-small and medium. Clinical Relevance Talus OCA plugs may provide a viable option for restoring congruity of the shoulder in patients with recurrent anterior glenohumeral instability and an HSL.
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Affiliation(s)
- Phob Ganokroj
- The Steadman Philippon Research Institute, Vail, Colorado, USA
- Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | | | | | | | | | - Ryan J. Whalen
- The Steadman Philippon Research Institute, Vail, Colorado, USA
| | | | - Matthew T. Provencher
- The Steadman Philippon Research Institute, Vail, Colorado, USA
- The Steadman Clinic, Vail, Colorado, USA
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Ganokroj P, Hollenbeck J, Peebles AM, Brown JR, Hanson JA, Whalen RJ, Golijanin P, Provencher CAPTMT. Humeral Head Reconstruction With Osteochondral Allograft: Bone Plug Optimization for Hill-Sachs Lesions Using CT-Based Computer Modeling Analysis. Orthop J Sports Med 2023; 11:23259671231193768. [PMID: 37693809 PMCID: PMC10483980 DOI: 10.1177/23259671231193768] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 05/03/2023] [Indexed: 09/12/2023] Open
Abstract
Background Engaging Hill-Sachs lesions (HSLs) pose a significant risk for failure of surgical repair of recurrent anterior shoulder instability. Reconstruction with fresh osteochondral allograft (OCA) has been proposed as a treatment for large HSLs. Purpose To determine the optimal characteristics of talus OCA bone plugs in a computer-simulated HSL model. Study Design Descriptive laboratory study; Level of evidence, 6. Methods Included were 132 patients with recurrent anterior instability with visible HSLs; patients who had multidirectional instability or previous shoulder surgery were excluded. Three-dimensional computed tomography models were constructed, and a custom computer optimization algorithm was generated to maximize bone plug surface area at the most superior apex (superiorization) and minimize its position relative to the most medial margin of the HSL defect (medialization). The optimal number, diameter, medialization, and superiorization of the bone plug(s) were reported. Percentages of restored glenoid track width and conversion from off- to on-track HSLs after bone plug optimization were calculated. Results A total of 86 patients were included in the final analysis. Off-track lesions made up 19.7% of HSLs and, of these, the mean bone plug size was 9.9 ± 1.4 mm, with 2.2 mm ± 1.7 mm of medialization and 3.3 mm ± 2.9 mm of superiorization. The optimization identified 21% of HSLs requiring 1 bone plug, 65% requiring 2 plugs, and 14% requiring 3 plugs, with a mean overall coverage of 60%. The mean width of the restored HSLs was 68%, and all off-track HSLs (n = 17) were restored to on-track. A Jenks natural-breaks analysis calculated 3 ideal bone plug diameters of 8 mm (small), 10.4 mm (medium), and 12 mm (large) in order to convert this group of HSLs to on-track. Conclusion Using a custom computer algorithm, we have demonstrated the optimal talus OCA bone plug diameters for reconstructing HSLs to successfully restore the HSL track and, on average, 60% of the HSL surface area and 68% of the HSL width. Clinical Relevance Reconstructing HSLs with talus OCA is a promising treatment option with excellent fit and restoration of HSLs. This study will help guide surgeons to optimize OCA bone plugs from the humeral head, femoral head, and talus for varying sizes of HSLs.
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Affiliation(s)
- Phob Ganokroj
- Steadman Philippon Research Institute, Vail, Colorado, USA
- Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | | | | | | | | | - Ryan J. Whalen
- Steadman Philippon Research Institute, Vail, Colorado, USA
| | - Petar Golijanin
- The University of Texas at Austin Dell Medical School, Austin, Texas, USA
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Liles JL, Peebles AM, Saker CC, Ganokroj P, Mologne MS, Provencher MT. Talar Allograft Preparation for Treatment of Reverse Hill-Sachs Defect in Recurrent Posterior Shoulder Instability. Arthrosc Tech 2022; 11:e1625-e1631. [PMID: 36185122 PMCID: PMC9520074 DOI: 10.1016/j.eats.2022.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 05/19/2022] [Indexed: 02/03/2023] Open
Abstract
Reverse Hill-Sachs lesions (rHSLs) after chronic posterior shoulder instability are important to recognize and treat appropriately. Treatment options for posterior instability with rHSL in the current literature are primarily based on percentage of humeral bone loss. In cases of moderate (25% to 50%) anterolateral humeral head bone loss, fresh osteochondral allografts are preferred. Recent literature has indicated that the talus serves as a robust grafting alternative site for the humeral head, as the talar dome shows high congruency and offers variable sizes. The purpose of this Technical Note is, therefore, to describe our technique for talus allograft preparation for the treatment of a large rHSL that highlights precise cutting anatomy, sizing options, and use of orthobiologics to ensure excellent talus union to the native humeral head surface.
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Affiliation(s)
| | | | | | - Phob Ganokroj
- The Steadman Philippon Research Institute, Vail, Colorado, U.S.A
- Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | | | - Matthew T. Provencher
- The Steadman Clinic, Vail, Colorado, U.S.A
- The Steadman Philippon Research Institute, Vail, Colorado, U.S.A
- Address correspondence to CAPT Matthew T. Provencher, M.D., M.B.A., M.C., U.S.N.R. (Ret.), Steadman, 13 Philippon Research Institute, The Steadman Clinic, 181 W. Meadow Dr., Ste 400, Vail, CO, 81657, U.S.A.
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Wang KC, Waterman BR, Cotter EJ, Frank RM, Cole BJ. Fresh Osteochondral Allograft Transplantation for Focal Chondral Defect of the Humerus Associated With Anchor Arthropathy and Failed SLAP Repair. Arthrosc Tech 2017; 6:e1443-e1449. [PMID: 29354455 PMCID: PMC5622598 DOI: 10.1016/j.eats.2017.06.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Accepted: 06/01/2017] [Indexed: 02/03/2023] Open
Abstract
Isolated, full-thickness articular cartilage lesions of the glenohumeral joint can cause pain, mechanical symptoms, and impaired function. Reports on operative management of these injuries with arthroscopic techniques, such as marrow stimulation, have shown improvement in patient symptoms. In cases where the subchondral bone is involved, osteochondral allograft (OCA) transplantation has shown positive results for contained, focal cartilage defects. The technique for OCA transplantation to treat Hill-Sachs lesions has been reported in detail, and there are multiple case series reporting on the outcomes of OCA used for this purpose. This Technical Note shows the application of OCA to treat a case of anchor arthropathy where a glenoid anchor placed during arthroscopic stabilization causes iatrogenic damage to the humeral head. This type of injury can result in cartilage lesions in uncommon locations, such as on the posterior humeral head. In this description, the technical pearls and pitfalls of managing difficult-to-access posterior humeral head lesions are presented along with the senior authors' general technique for OCA to treat focal lesions of the humeral head cartilage.
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Affiliation(s)
| | | | | | | | - Brian J. Cole
- Address correspondence to Brian J. Cole, M.D., M.B.A., Department of Orthopaedic Surgery, 1611 W Harrison Street, Suite 300, Chicago, IL 60612, U.S.A.Department of Orthopaedic Surgery1611 W Harrison Street, Suite 300ChicagoIL60612U.S.A.
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Saltzman BM, Leroux T, Cole BJ. Management and Surgical Options for Articular Defects in the Shoulder. Clin Sports Med 2017; 36:549-572. [DOI: 10.1016/j.csm.2017.02.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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