Humeral Head Reconstruction With Osteochondral Allograft: Bone Plug Optimization for Hill-Sachs Lesions Using CT-Based Computer Modeling Analysis.
Background: Engaging Hill-Sachs lesions (HSLs) pose a significant risk for failure of surgical repair of recurrent anterior shoulder instability. Reconstruction with fresh osteochondral allograft (OCA) has been proposed as a treatment for large HSLs. Purpose: To determine the optimal characteristics...
| Publicado en: | Orthopaedic Journal of Sports Medicine Vol. 11; no. 9; pp. 1 - 9 |
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| Autores principales: | , , , , , , , |
| Formato: | equations & formulas pictorial research tables/charts Journal Article |
| Publicado: |
Sage Publications Inc.
Sep2023
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| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=172447009&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 172447009 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 23259671 FUGT jtl: Orthopaedic Journal of Sports Medicine issn: 23259671 maglogo: Y pubinfo: dt: Sep2023 vid: 11 iid: 9 pid: 344 pub: Sage Publications Inc. place: Thousand Oaks, California artinfo: ui: 172447009 172447009 172447009 10.1177/23259671231193768 172447009 ppf: 1 ppct: 8 formats: tig: atl: Humeral Head Reconstruction With Osteochondral Allograft: Bone Plug Optimization for Hill-Sachs Lesions Using CT-Based Computer Modeling Analysis. aug: au: Ganokroj, Phob Hollenbeck, Justin Peebles, Annalise M. Brown, Justin R. Hanson, Jared A. Whalen, Ryan J. Golijanin, Petar Provencher, CAPT Matthew T. affil: Steadman Philippon Research Institute, Vail, Colorado, USA. sug: subj: Tomography, X-Ray Computed Humeral Fractures Surgery Hill-Sachs Lesion Surgery Hill-Sachs Lesion Pathology Surgery, Reconstructive Methods Allografts Cartilage, Articular Shoulder Instability, Anterior Surgery Bone Transplantation Computer Simulation Bankart Lesions Imaging, Three-Dimensional Algorithms Human Male Female Young Adult Adult Data Analysis Software Descriptive Statistics Glenohumeral Joint Joint Instability Surgery Adult: 19-44 years Male Female ab: Background: Engaging Hill-Sachs lesions (HSLs) pose a significant risk for failure of surgical repair of recurrent anterior shoulder instability. Reconstruction with fresh osteochondral allograft (OCA) has been proposed as a treatment for large HSLs. Purpose: To determine the optimal characteristics of talus OCA bone plugs in a computer-simulated HSL model. Study Design: Descriptive laboratory study; Level of evidence, 6 Methods: Included were 132 patients with recurrent anterior instability with visible HSLs; patients who had multidirectional instability or previous shoulder surgery were excluded. Three-dimensional computed tomography models were constructed, and a custom computer optimization algorithm was generated to maximize bone plug surface area at the most superior apex (superiorization) and minimize its position relative to the most medial margin of the HSL defect (medialization). The optimal number, diameter, medialization, and superiorization of the bone plug(s) were reported. Percentages of restored glenoid track width and conversion from off- to on-track HSLs after bone plug optimization were calculated. Results: A total of 86 patients were included in the final analysis. Off-track lesions made up 19.7% of HSLs and, of these, the mean bone plug size was 9.9 ± 1.4 mm, with 2.2 mm ± 1.7 mm of medialization and 3.3 mm ± 2.9 mm of superiorization. The optimization identified 21% of HSLs requiring 1 bone plug, 65% requiring 2 plugs, and 14% requiring 3 plugs, with a mean overall coverage of 60%. The mean width of the restored HSLs was 68%, and all off-track HSLs (n = 17) were restored to on-track. A Jenks natural-breaks analysis calculated 3 ideal bone plug diameters of 8 mm (small), 10.4 mm (medium), and 12 mm (large) in order to convert this group of HSLs to on-track. Conclusion: Using a custom computer algorithm, we have demonstrated the optimal talus OCA bone plug diameters for reconstructing HSLs to successfully restore the HSL track and, on average, 60% of the HSL surface area and 68% of the HSL width. Clinical Relevance: Reconstructing HSLs with talus OCA is a promising treatment option with excellent fit and restoration of HSLs. This study will help guide surgeons to optimize OCA bone plugs from the humeral head, femoral head, and talus for varying sizes of HSLs. pubtype: Academic Journal doctype: equations & formulas pictorial research tables/charts Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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