Allografts in the Treatment of Athletic Injuries of the Shoulder

Abstract

As allogeneic musculoskeletal tissue is readily available, has minimal limitation in size or shape, and carries no donor site morbidity, it has become attractive for use in reconstructive shoulder surgery. Allograft is a viable option for treating osseous defects associated with glenohumeral instability and has been shown to achieve a stable shoulder with good clinical outcomes. Although there are mixed results on the use of allograft as rotator cuff augments or substitutes, new commercially processed materials such as GraftJacket are being tested to address the high failure rates associated with massive rotator cuff repair. Interposition arthroplasty as a treatment for glenohumeral arthritis in the young and active patient is a novel concept in which the arthritic glenoid is biologically resurfaced. Satisfactory results have been described using lateral meniscus and Achilles tendon allograft. Despite the promising reports on the use of allograft in reconstructive shoulder surgery, most of the published literature exists as retrospective, case reports. Additional large, controlled research is needed to prove the efficacy and safety of allograft tissue in the treatment of athletic injuries of the shoulder.

Rekonstruktion anteromedialer Humeruskopfimpressionsfrakturen mit knöchernen Auto- oder Allografts

“…Allografts (allogene Knochentransplantate) werden zur Behandlung von diversen traumatologischen und orthopädi-schen Verletzungen/Erkrankungen mit größerem Knorpel-/Knochensubstanzverlust eingesetzt [14,15]. Deren Anwendung nahm über die letzten Jahre kontinuierlich zu [16].…”

Management of cartilage defects in the shoulder

“…Allograft transplantation is becoming a viable option for the repair of various musculoskeletal disorders [44]. The technique works similar to autograft transplantation with two major advantages: a lack of donor site morbidity and its application to more extensive defects.…”

Arthroscopic treatment of early glenohumeral arthritis

“…Viscosupplementation using hyaluronic acid may be a useful treatment option in patients who have shoulder osteoarthritis with an intact rotator cuff [14], while less satisfactory results have been obtained in those with rotator cuff tears or advanced osteoarthritis [15]. Several surgical options are available to manage primary shoulder arthritis, including simple arthroscopic joint debridement [16] and more complex techniques such as resurfacing using fascia lata or meniscus [17], osteochondral autologous transplantation [18], resurfacing arthroplasty [19], and total arthroplasty [20]. The use of microfractures to treat full-thickness chondral defects is a viable option that provides good results in young patients, with the greatest improvements seen for smaller lesions of the humerus and the worst results observed in patients with bipolar lesions [21], even when the microfracture is covered with a periosteal flap [22].…”