Mid-Term outcomes following fresh-frozen humeral head osteochondral allograft reconstruction for reverse Hill Sachs lesion: a case series

Abstract

Background Locked posterior glenohumeral dislocations with a reverse Hill-Sachs impaction fracture involving less than 30% of the humeral head are most frequently treated with lesser tuberosity transfer into the defect, whereas those involving more than 50% undergo humeral head arthroplasty. Reconstruction of the defect with segmental femoral osteochondral allografts has been proposed to treat patients between these two ranges, but the medium−/long-term outcomes of this joint-preserving procedure are controversial. Methods Between 2001 and 2018, 12 consecutive patients with a unilateral locked posterior shoulder dislocation and an impaction fracture from 30 to 50% (mean 31%\u2009±\u20091.32) of the humeral head were treated with segmental reconstruction of the defect with fresh-frozen humeral head osteochondral allografts. Patients were assessed clinically, radiographically and with computed tomography (CT) at a medium follow-up of 66\u2009±\u200950.25\u2009months (range, 24–225). Results All twelve shoulders presented a slight limitation in anterior elevation (average, 166.6°\u2009±\u200922.76). The mean active external rotation with the shoulder at 90° of abduction was 82.5°\u2009±\u20096.61, and that with the arm held in stable adduction was 79.16\u2009±\u200918.80. The mean abduction was 156.25°\u2009±\u200925.09. The mean Constant-Murley score (CS) was 82\u2009±\u200915.09 points (range, 40–97 points), and the mean ASES was 94\u2009±\u20098.49 points. The mean pre- and postoperatively Western Ontario Shoulder Instability index (WOSI) was 236.5\u2009±\u2009227.9 and 11.20\u2009±\u200910.85, respectively. Development of osteoarthrosis (OA) was minimal. The average allograft resorption rate was 4%\u2009±\u20092.4. There were no cases of failure (reoperation for any reason) in this series. Conclusion Segmental humeral head reconstruction with humeral head fresh-frozen osteochondral allografts provides good to excellent clinical results with low-grade OA and low allograft resorption in patients with locked posterior shoulder dislocation. Trial registration ClinicalTrials.gov PRS, ClinicalTrials.gov ID: NCT04823455 . Registered 29 March 2021 - Retrospectively registered, https://register.clinicaltrials.gov/prs/app/action/SelectProtocol?sid=S000AU8P&selectaction=Edit&uid=U0004J36&ts=12&cx=6cykp8 Level of evidence Level IV, Case Series, Treatment Study.