Bipolar Bone Loss of the Shoulder Joint due to Recurrent Instability: Use of Fresh Osteochondral Distal Tibia and Humeral Head Allografts

Abstract

With increasing shoulder instability events, the likelihood of a bony lesion of the glenoid and/or humeral head rises. Although bone loss of either the glenoid or humeral head may result in recurrent instability, bipolar lesions have been shown, in particular, to result in a negative and additive effect on glenohumeral stability. In the case of a bipolar lesion comprising severe glenoid bone loss and an engaging, "off-track" Hill-Sachs lesion, the bony foundation of the glenohumeral joint is compromised and bony augmentation is necessary. We present our preferred technique, made up of the application of a distal tibia allograft to address the glenoid bone loss and humeral head allograft to address the HillSachs lesion, for the treatment of a severe bipolar lesion in the setting of recurrent anterior shoulder instability after a failed Latarjet procedure.

Bulk osteochondral allograft for massive Hill–Sachs defect combined with Latarjet procedure for bipolar bone loss in anterior instability

“…All 10 patients were male (Table 1). The average age of the time of surgery was 28 years (21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34). The cohort had endured an average of 5.3 years (1-15) of anterior instability and have experienced on average 7 dislocations (4-16) before the combined humeral head reconstruction and Latarjet operation.…”

“…Only one study has reported simultaneous Hill–Sachs and anteroinferior glenoid reconstruction. Haber et al 32 published a case report in which distal tibial allograft (DTA) was used for glenoid reconstruction together with allograft Hill–Sachs reconstruction. Their rationale for DTA over Latarjet is that the former has better joint congruity and denser trabecular matrix, making it an optimal graft.…”

Return to Professional Australian Rules Football After Surgery for Traumatic Anterior Shoulder Instability

“…A Latarjet was also indicated in the case of significant glenoid bone loss and/or significant bipolar lesions (bony lesions of both glenoid and humeral head). 16 If a player's career was at a pivotal point at which an incidence of recurrence may be career ending, 25 a primary Latarjet was considered. Similarly, in the case of a primary dislocation on the contralateral shoulder, a primary Latarjet was often considered to reduce the risk of recurrence and additional time out of competition.…”

Use of Allografts in Orthopaedic Surgery: Safety, Procurement, Storage, and Outcomes

“…27 Patients younger than 20 years, generally the age group most susceptible to such dislocations, demonstrate a 95% rate of recurrence. 14,27 Combining this information with Nakagawa et al's 47 report that 60% of patients with traumatic anterior shoulder instability had bipolar lesions (glenoid and humeral head), the value of a procedure that can restore bony integrity to the glenohumeral joint is clear. Humeral head and distal tibial allografts (Figure 4) provide orthopaedic surgeons with 2 options for accomplishing this restoration.…”