Purpose: To evaluate survivorship, patient satisfaction, and long-term functional outcomes of osteochondral allograft (OCA) transplantation to the humeral head in patients with isolated focal chondral defects.

Methods: A registry of consecutive patients undergoing OCA transplantation to the humeral head between 2004 and 2012 was retrospectively reviewed. Medical records of patients were reviewed to collect baseline demographic data and prospectively maintained preoperative outcome assessments. Treatment failures were defined as patients undergoing conversion to total shoulder arthroplasty (TSA). Patients were contacted to complete postoperative Simple Shoulder Test (SST), American Shoulder and Elbow Surgeons Shoulder Score (ASES), and Short Form 12 (SF-12) Physical and Mental outcome assessments. Patient satisfaction and sport activity outcomes were also assessed. The postoperative outcomes obtained were compared to baseline scores using Student’s t-testing, with statistical significance defined as p<0.05.

Results: 22 patients were identified in the study period, of which 13 (59%) had completed follow-up and were included in the analysis. Five patients (38.6%) were identified as treatment failures and underwent TSA at an average 3.91 ± 4.25 years (range 0.97-11.0) after index surgery. The remaining eight patients (4 females, 4 males, mean age 26.8 ± 10.2 years) completed outcome assessments at an average follow-up of 12.0 ± 3.1 years (range 7.6-15.7 years). While mean outcome scores of all physical function assessments were higher at final follow-up than at baseline, the difference was significant only in SST scores (Table 1). Patient satisfaction varied, with four patients reporting extreme satisfaction, one reporting moderate satisfaction, two reporting somewhat satisfaction, and one reported he was unsatisfied with the procedure. All eight patients were participating in sport activities at the time of surgery (4 collegiate, 1 competitive, and 3 recreational athletes). Of those, only three (one collegiate, one competitive, and one recreational athlete) were able to return to their usual sport, two of whom at the same level of competition and one at a lower level of competition.

Conclusion: The results of this small case series suggest that the reported short and mid-term outcome improvements of OCA transplantation to the humeral head diminish at long-term time points, with a substantial proportion of patients requiring conversion to shoulder arthroplasty. Moreover, athletes should be counselled of the low probability of being able to return to prior sport following this procedure. Despite these limitations of the procedure, patient satisfaction rates with regards to long-term outcome are generally favorable.

Table 1: Pre and post-operative outcome assessments collected at an average 12.03 years. Five patients identified as treatment failures at follow-up were not assessed due to crossover.