Normal curvature of glenoid surface can be restored when performing an inlay osteochondral allograft: an anatomic computed tomographic comparison

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Various techniques for cartilage repair and resurfacing have been described in the literature for many different joints. The use of osteochondral allografts has shown to be one of the best options that can restore mature hyaline cartilage in a biological and structurally appropriate manner. Success can be attributed to research dedicated to improved harvesting, storage, and chondrocyte preservation in addition to transplantation techniques. While these grafts are commonly used in the knee, there is a paucity of data regarding grafting of the shoulder.

Given the poor results of shoulder arthroplasty in young patients, alternative surgical treatments are available but success is not as good as desired. Some of the available options are interposition arthroplasty with or without hemiarthroplasty using graft options: anterior capsule, fascia lata, achilles allograft, lateral meniscal allograft, dura mater, and porcine submucosa. Satisfaction results have been reported as follows: 50 % excellent, 36 % satisfactory, and 14 % unsatisfactory for biologic glenoid resurfacing with hemiarthroplasty.

Studies have previously focused on documenting glenoid anatomic characteristics such as size, inclination, and version. The morphology of the scapula has been studied mainly for prosthesis implant placement and orientation, but further information may be useful due to new trends to treat chondral problems in young patients in a biological way. To appropriately resurface a joint, the donor graft must anatomically match the native surface to be reconstructed; therefore, we have undertaken this study to compare the convexity of the glenoid with that of the medial proximal tibia to ascertain whether this would be an appropriate source for osteochondral allografting. This is relevant as one of the current principal limitations in the United States of America for glenoid resurfacing is fresh glenoid allograft availability. Presently, medial tibial plateau grafts are much more widely available.

The study hypothesis was focused on the concept that there is a similar anatomic relationship between the glenoid and the medial tibial plateau based on clinical observations. This concept is important in determining whether medial tibia plateau allografts could be used as inlay glenoid allografts for glenoid reconstruction in joint-preserving surgery. There are published techniques using distal tibia as an allograft source for instability and bone loss procedures, but the anatomic relationships between the joint and graft surfaces have never been studied to our knowledge.

Full Article: Normal curvature of glenoid surface can be restored when performing an inlay osteochondral allograft: an anatomic computed tomographic comparison

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