Fresh Osteochondral Allograft Transplantation for Focal Chondral Defect of the Humerus Associated With Anchor Arthropathy and Failed SLAP Repair

Figures

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  Fig 1. (A) Axial image of a T2-weighted magnetic resonance arthrogram of the left shoulder at the level of the mid-glenoid showing focal high-grade cartilage loss of the posterior inferior aspect of the humeral head with underlying subchondral edema. (B) Axial image of a T2-weighted magnetic resonance arthrogram at the level of the mid-glenoid showing a low-intensity implant of the left shoulder in the posterosuperior glenoid with intra-articular protrusion adjacent to the focal area of humeral chondral loss. This is consistent with a prominent, malpositioned PEEK (polyether ether ketone) suture anchor from prior superior labral repair.

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  Fig 2. (A) Lazy beach-chair positioning on a Jackson table allows for access to posterior lesions of the humeral head. In this figure, this positioning is demonstrated for a posterior humeral head lesion of the left shoulder. After tenotomy of the superior half of the subscapularis tendon, the arm is abducted, extended, and externally rotated to dislocate the humeral head. In this case, patient positioning and exposure for a posterior lesion of the left humeral head are depicted. (B) A retractor is used to lift and expose the posterior humeral head. The retractor is placed on the bare area of the humeral head to avoid iatrogenic cartilage injury; in this case, a Chandler retractor is used as a lever to dislocate the humeral head and facilitate appropriate exposure of the lesion site. In this photograph, the articular cartilage defect has already been reamed in preparation for the OCA.

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  Fig 3. In this figure, the patient is positioned in the lazy beach chair position. The left shoulder is depicted. (A) Measuring the defect using a cannulated cylindrical sizing guide (labeled). The guide pin is placed at the center of the lesion with the sizing guide in place to ensure appropriate placement. Images from the original case for this step of the procedure were unavailable; this image depicts defect sizing for a patient with an isolated articular cartilage lesion of the central humeral head of the left shoulder. A self-retaining retractor can be useful in exposing the defect. (B) A coring drill (labeled) is used to score the articular cartilage before reaming. This ensures a clean edge by preventing shearing of the articular cartilage during reaming. Care must be taken to avoid damage to the sutures securing the subscapularis during coring and reaming.

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  Fig 4. (A) Preparing the humeral head allograft. The graft is warmed in room temperature saline before implantation. Saline irrigation is used during harvesting to prevent heat necrosis. During harvest, a bushing is used to stabilize the graft and serve as a guide during harvesting. This should be sized to fit the coring drill used to harvest the graft. An assistant is necessary to stabilize the bushing during harvest, and an additional assistant can be helpful to irrigate the graft during harvesting. (B) After measurement, the donor plug is press-fit into the freshly reamed defect. The head of the graft impactor should be larger than the graft itself. This prevents overimpaction of the graft. The plug is gently impacted to ensure a flush fit.