VIDEO: Talus osteochondral allograft may be optimal bone plug for Hill-Sachs lesions
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LAS VEGAS — In this video, Phob Ganokroj, MD, of Bangkok, discusses a study done at The Steadman Philippon Research Institute in which talus osteochondral allografts converted off-track Hill-Sachs lesions to on-track lesions.
Ganokroj, Matthew T. Provencher, MD, and colleagues studied talus osteochondral allografts (OCAs), which have been shown to a have high congruence match for the humeral head, as well as variable sizes. They sought to determine the optimal characteristics of these allografts when used to treat Hill-Sachs lesions of the humeral head.
“To use a single graft or multiple OCA grafts may be a good alternative option because it is technically easier and maybe can be used as an arthroscopic technique in the future,” Ganokroj told Healio.
Using a computer model they developed from a 3D CT scan of the shoulder of a patient with shoulder instability, researchers placed OCAs in the most medial and superior regions of the humeral heads of 3D models made from CT scans of about 86 patients with unstable shoulders. These regions are both “risk factors for the engagement of the Hill-Sachs lesions,” Ganokroj, of the Faculty of Medicine Siriraj Hospital, Mahidol University, , said. Of the patients studied, 20% had off-track lesions.
Researchers then studied possible sizes and locations of Hill-Sachs lesions and optimal OCA bone plug quantity and diameters, as well as other aspects of humeral head reconstruction.
“From our results, we have shown that after we used the bone plug optimization, nearly 70% can restore after our bone plug optimization. And all off-track lesions can be converted into on-track lesion,” Ganokroj said.
Additional analyses showed the optimal bone plug sizes to fill small, medium and large Hill-Sachs lesions were about 8 mm, 10.4 mm and 12 mm, respectively, according to the findings.
“[W]e think that the bone plug optimization is one of the alternative good options that can restore more of the Hill-Sachs lesion and convert off-track into on-track lesions, but additional clinical work needs to validate this procedure,” Ganokroj said.
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Ganokroj P, et al. Poster 827. Presented at: American Academy of Orthopaedic Surgeons Annual Meeting; March 7-11, 2023; Las Vegas.
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