Osteochondritis dissecans on the medial aspect of the humeral head

Bilateral osteochondritis dissecans of the shoulder

Osteochondritis dissecans as a pathology is pre-dominantly described in the knee, elbow and ankle. Osteochondritis dissecans of the humeral head is a more uncommon reported injury. We present a case of a bilateral osteochondritis dissecans of the humeral head in a 16-year-old soccer player and an algorithm for treatment of OCD of the humeral head. To our knowledge this has never been described so specifically in literature before.

Articular Cartilage Defects of the Glenohumeral Joint: A Systematic Review of Treatment Options and Outcomes

OBJECTIVE

To report radiographic and magnetic resonance imaging findings, patient-reported outcomes, and complications and/or reoperations following nonarthroplasty surgical intervention for focal glenohumeral cartilage defects.

DESIGN

A literature search was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. Patients were included if they possessed a chondral defect of the humeral head, glenoid, or both, which had been treated with a joint preserving nonarthroplasty procedure. Risk of bias assessment was performed using the Methodological Index for Non-Randomized Studies scoring system. Study demographics, surgical technique, imaging findings, patient-reported outcomes, complications, failures, and reoperations were collected.

RESULTS

Fourteen studies with 98 patients (100 shoulders) met the inclusion criteria. Patient ages ranged from 7 to 74 years. The nonarthroplasty surgical techniques utilized included microfracture (67 shoulders), osteochondral transplantation (28 shoulders), chondrocyte transplantation (4 shoulders), and internal fixation (1 shoulder). The rates of radiographic union and progression of osteoarthritis ranged between 90% to 100% and 57% to 100%, respectively. Visual analog scores ranged from 0 to 1.9 at final follow-up. Mean postoperative ASES (American Shoulder and Elbow Surgeons) shoulder scores ranged from 75.8-100. Mean postoperative CSS (Constant Shoulder Score) scores ranged from 83.3-94. Mean postoperative SSV (Subjective Shoulder Value) ranged from 70% to 99%. Failure and reoperation rates ranged between 0% to 35% and 0% to 30%, respectively, with the most common reoperation being conversion to prosthetic arthroplasty.

CONCLUSIONS

In this systematic review, nonarthroplasty surgical techniques demonstrated acceptable rates of radiographic healing, improved patient reported outcomes, minimal complications, and low rates of failure or reoperation. Joint preserving techniques are likely viable options to prolong function of the native shoulder and provide short- to midterm pain relief in young and highly active patients.

LEVEL OF EVIDENCE

Level IV.

Shearing Osteochondral Fracture of the Humeral Head: A Case Report

CASE

A 30-year-old man was found to have a posteriorly displaced osteochondral shear fracture of his left humeral head, likely from dislocation and relocation. The fragment was fixed in its native position using headless screws, and the patient regained full strength and range of motion within 9 months.

CONCLUSIONS

Osteochondral shear fractures of the humeral head appear to shear off the anteromedial articular joint surface after dislocation and relocation. One should be suspicious for associated labral tears. Arthroplasty is a valid treatment option, but select patients may be eligible for other viable options.

Management of Articular Cartilage Defects in the Glenohumeral Joint

Articular cartilage defects are not often encountered in the glenohumeral joint. These lesions are typically found in patients with shoulder trauma, recurrent instability, or previous surgical treatment. Diagnosis can be difficult; these defects are often found incidentally during arthroscopic or open surgical management of other pathology. Initial management of isolated glenohumeral chondral defects is nonsurgical and includes physical therapy and/or corticosteroid injections. If nonsurgical treatment is unsuccessful, patients may undergo surgery. Because these lesions occur infrequently, few studies have documented surgical techniques and outcomes. Surgical strategies include arthroscopic débridement, microfracture surgery, osteochondral autograft or allograft transplantation, autologous chondrocyte implantation, and particulated juvenile allograft cartilage implantation.

Arthroscopic Osteochondral Autograft Transfer for Juvenile Osteochondritis Dissecans of the Humeral Head: A Case Report

CASE

Osteochondritis dissecans (OCD) rarely affects the humeral head. We describe a 14-year-old adolescent who, despite conservative treatment, had persistent pain in the left shoulder as well as limited function. Radiographs and a computed tomography (CT) arthrogram revealed an osteochondral defect of the humeral head. He was managed with an arthroscopic osteochondral autograft transfer from the knee, which provided a satisfactory outcome.

CONCLUSION

Arthroscopic osteochondral autograft transfer is an effective option for the treatment of OCD of the humeral head.