The ability of massive osteochondral allografts from the medial tibial plateau to reproduce normal joint contact pressures after glenoid resurfacing: the effect of computed tomography matching

Peter J Millett; Simon A Euler; Grant J Dornan; Sean D Smith; Tyler Collins; Max P Michalski; Ulrich J Spiegl; Kyle S Jansson; Coen A Wijdicks

doi:10.1016/j.jse.2014.09.033

The ability of massive osteochondral allografts from the medial tibial plateau to reproduce normal joint contact pressures after glenoid resurfacing: the effect of computed tomography matching

J Shoulder Elbow Surg. 2015 May;24(5):e125-34. doi: 10.1016/j.jse.2014.09.033. Epub 2014 Nov 6.

Authors

Peter J Millett¹, Simon A Euler², Grant J Dornan³, Sean D Smith³, Tyler Collins¹, Max P Michalski³, Ulrich J Spiegl⁴, Kyle S Jansson³, Coen A Wijdicks³

Affiliations

¹ Steadman Philippon Research Institute, Vail, CO, USA; The Steadman Clinic, Vail, CO, USA.
² Steadman Philippon Research Institute, Vail, CO, USA; The Steadman Clinic, Vail, CO, USA; Department of Trauma Surgery and Sports Traumatology, Medical University Innsbruck, Innsbruck, Austria. Electronic address: simon.euler@uki.at.
³ Steadman Philippon Research Institute, Vail, CO, USA.
⁴ Steadman Philippon Research Institute, Vail, CO, USA; The Steadman Clinic, Vail, CO, USA; Department of Trauma and Reconstructive Surgery, University of Leipzig, Leipzig, Germany.

PMID: 25457785
DOI: 10.1016/j.jse.2014.09.033

Abstract

Background: Current techniques for resurfacing of the glenoid in the treatment of arthritis are unpredictable. Computed tomography (CT) studies have demonstrated that the medial tibial plateau has close similarity to the glenoid. The purpose of this study was to assess contact pressures of transplanted massive tibial osteochondral allografts to resurface the glenoid without and with CT matching.

Methods: Ten unmatched cadaveric tibiae were used to resurface 10 cadaveric glenoids with osteochondral allografts. Five cadaveric tibiae and glenoids were CT matched and studied. An internal control group of 4 matched pairs of glenoids, with the contralateral glenoid transplanted to the opposite glenoid, was also included as a best-case scenario to measure the effects of the surgical technique. All glenoids were tested before and after grafting at different abduction and rotation angles, with recording of peak contact pressures.

Results: Peak contact pressures were not different from the intact state in the autografted group but were increased in both allografted groups. CT-matched tibial grafts had lower peak pressures than unmatched grafts. Peak pressures were on average 24.8% (range [18.3%, 29.6%]) greater than in the native glenoids for unmatched allografts, 21.8% ([17.0%, 25.5%]) greater for the matched allografts, and 4.9% ([3.8%, 5.5%]) greater for matched autografts.

Conclusion: Osteochondral grafting from the medial tibial plateau to the glenoid is feasible but results in increased peak contact pressures. The technique is reproducible as defined by the autografted group. Contact pressures between native and allografted glenoids were significantly different. The clinical significance remains unknown. Peak pressures experienced by the glenoid seem highly sensitive to deviations from the native glenoid shape.

Keywords: CT matching; Shoulder osteoarthritis; cartilage restoration; medial tibial plateau; osteochondral grafting.

MeSH terms

Adult
Aged
Allografts
Arthroplasty
Bone Transplantation*
Cadaver
Cartilage / transplantation
Epiphyses / transplantation
Female
Glenoid Cavity / diagnostic imaging*
Glenoid Cavity / surgery*
Humans
Middle Aged
Osteoarthritis / surgery
Pressure
Rotation
Tibia / diagnostic imaging*
Tibia / transplantation*
Tomography, X-Ray Computed*