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Osteochondral allograft transplantation for articular humeral head defect from ballistic trauma
Soderquist, Melissa Barnes, Leslie
Soderquist, Melissa
Barnes, Leslie
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Journal article
Date
2024-05-06
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Orthopaedic Surgery and Sports Medicine
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https://doi.org/10.1016/j.xrrt.2024.04.008
Abstract
Extremity injuries from ballistic trauma are common; however, most ballistic fractures are to the lower extremity and make up the primary focus of existing orthopedic literature. Orthopedic injuries as a result of ballistic trauma are heterogeneous in nature and outcomes are typically impacted by degree of bone loss, bone exposure, and the extent of soft tissue injury. There is a paucity of information regarding articular cartilage defects from penetrating trauma. Articular cartilage defects present a particular challenge in the glenohumeral joint for the orthopedic surgeon and patient. These defects are less frequently encountered in the glenohumeral joint and are typically the result of closed shoulder trauma, recurrent instability, or previous surgery. Healing capacity for these defects is limited. Treatment of glenohumeral articular cartilage defects is a challenge in part due to the anatomic and biomechanical nature of the glenohumeral joint itself, including the relatively thin articular cartilage present on the humeral head and the high shear stresses experienced during rotation. Multiple different procedures have been developed for these defects, focused on providing pain relief and restoring the articular surface. Osteochondral allograft transplantation (OCA), osteochondral autograft transplantation, debridement, microfracture, and autologous cartilage implantation (ACI)/matrix-associated ACI are viable options to treat patients with osteochondral defects; however, defect size and bone loss are among important considerations when selecting an appropriate treatment option. Articular cartilage defects have been extensively studied in the knee. Investigations have shown microfracture to be beneficial in lesions less than 2 cm2 without subchondral bone loss26; full-thickness cartilage lesions between 2 and 4 cm2 can be addressed using ACI or osteochondral autograft transfer. Lesions greater than 4 cm2 can be addressed using ACI or OCA. OCA was initially utilized by Erich Lexer in 1908 and has been regularly used in the United States for over 40 years.5 Advantages of OCA include its applicability to varying size defects with subchondral bone involvement, it does not require a border of healthy cartilage, it is not impacted by prior microfracture procedures, has no donor site morbidity, and it allows for faster rehabilitation. Disadvantages include its availability, cost, limited options in the instance of graft failure, and operative learning curve. OCA is indicated for young active patients with full-thickness focal lesions greater than 1 cm2 that cannot undergo other restorative procedures such as arthroplasty, ACI, or autograft transplantation procedures due to age, defect size, depth, and location. Contraindications include advanced osteoarthritis and chronic post-traumatic defects. Much of the current data for osteochondral allograft use in the shoulder are from patients with documented instability. This report presents the surgical technique and case of a patient with a full-thickness articular cartilage defect of the humeral head as the result of ballistic trauma with treatment using OCA.
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Citation
Melissa Soderquist, Leslie Barnes, Osteochondral allograft transplantation for articular humeral head defect from ballistic trauma, JSES Reviews, Reports, and Techniques, 2024, ISSN 2666-6391, https://doi.org/10.1016/j.xrrt.2024.04.008.
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Elsevier
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JSES Reviews, Reports, and Techniques, Vol. 4, Iss. 3
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