Houston Methodist Orthopedics & Sports Medicine, Houston, TX, USA.
Texas Tech University Health Sciences Center, Department of Orthopaedic Surgery & Rehabilitation, Lubbock, TX, USA.
J Shoulder Elbow Surg. 2024 Dec;33(12):2800-2804. doi: 10.1016/j.jse.2024.06.008. Epub 2024 Aug 2.
Osteochondral allograft (OCA) transplantation is a well-described technique for the treatment of large, engaging Hill-Sachs lesions (HSLs). Traditionally, OCAs are size-matched to the defect, which can be expensive and time-consuming, and the majority of described techniques require an open approach. Recently, an all-arthroscopic approach to Hill-Sachs OCA transplantation using premade plugs was described, eliminating the need for size-matching and graft harvest. The purpose of this study was to evaluate postoperative outcomes of patients who have undergone arthroscopic treatment of HSLs using premade OCA plugs. We hypothesized that these patients would have improved pain and function without recurrent instability.
A retrospective chart review was performed using operative reports for a single surgeon with search terms Hill-Sachs and allograft. Patients were excluded if an open approach was used or if graft harvest was performed. Postoperative imaging was reviewed to assess for graft incorporation and reconstitution of the HSL. Recurrent instability and reoperation were recorded. Patients completed surveys including the American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES) score and the Western Ontario Shoulder Instability Index (WOSI).
Five patients were identified through chart review and met inclusion criteria. All patients underwent concurrent labral repair and 2 patients underwent a concurrent open Latarjet procedure. Postoperative radiographs showed reconstitution of the HSLs in all patients. There were no complications in the postoperative period with no recurrent instability or reoperations in any patient. The average ASES score was 87% (higher score indicating better outcome) with standard deviation 9.7, and the average WOSI score was 27% (lower score indicating better outcome) with standard deviation 8.3.
Favorable outcomes can be expected after arthroscopic treatment of Hill-Sachs lesions using premade OCA plugs. Further research is needed to assess larger patient cohorts and compare outcomes to size-matched approaches.
骨软骨同种异体移植（OCA）是治疗大的、活动性 Hill-Sachs 损伤（HSL）的一种成熟技术。传统上，OCA 与缺损大小匹配，这既昂贵又耗时，而且大多数描述的技术都需要开放方法。最近，描述了一种使用预制插件进行全关节镜下 Hill-Sachs-OCA 移植的方法，消除了大小匹配和移植物采集的需要。本研究的目的是评估接受关节镜治疗 HSL 使用预制 OCA 插件的患者的术后结果。我们假设这些患者的疼痛和功能会得到改善，且不会出现复发性不稳定。
使用单一外科医生的手术报告进行回顾性图表审查，并使用 Hill-Sachs 和同种异体两个搜索词。如果使用开放方法或进行移植物采集，则排除患者。对术后影像学进行评估，以评估移植物的融合和 HSL 的重建。记录复发性不稳定和再次手术。患者完成了包括美国肩肘外科医生协会（ASES）标准肩部评估表（ASES）评分和西部安大略省肩部不稳定指数（WOSI）在内的调查。
通过图表审查确定了 5 名符合纳入标准的患者。所有患者均行同期肩袖撕裂修补术，2 例患者行同期开放 Latarjet 手术。术后 X 线片显示所有患者 HSL 均重建。术后无并发症，无患者出现复发性不稳定或再次手术。平均 ASES 评分为 87%（得分越高表明结果越好），标准差为 9.7，平均 WOSI 评分为 27%（得分越低表明结果越好），标准差为 8.3。
使用预制 OCA 插件进行关节镜下治疗 Hill-Sachs 损伤可获得良好的结果。需要进一步研究来评估更大的患者队列，并将结果与大小匹配的方法进行比较。
