This narrative review surveys osteochondral allograft use across the shoulder. It covers anterior glenoid reconstruction, large Hill-Sachs defects, and focal chondral lesions. The authors weigh graft options, technical considerations, and the limits of current evidence.
When you evaluate a shoulder that failed stabilization, quantify the bone loss first. Biomechanical stability degrades once glenoid loss reaches 15% to 20%, and reconstruction is indicated beyond 20% to 25%. A 30% defect raises contact pressures 300% to 400%, so leaving it unaddressed sets up recurrence.
The key mental model: match graft curvature to the joint. Distal tibial allograft fits the glenoid radius in 94% of specimens and beats a cartilage-free coracoid on contact mechanics, which is why it is gaining traction for anterior reconstruction.
For Hill-Sachs lesions, use the glenoid track (83% of glenoid width) to decide. Off-track lesions engage and often need a humeral-head allograft to restore geometry and prevent engagement. Remember the logistics: fresh grafts preserve chondrocytes but viability falls off after 28 days, so counsel the patient about the wait and the roughly 2-week scheduling window.
This narrative review surveys osteochondral allograft use across the shoulder. It covers anterior glenoid reconstruction, large Hill-Sachs defects, and focal chondral lesions. The authors weigh graft options, technical considerations, and the limits of current evidence.
When you evaluate a shoulder that failed stabilization, quantify the bone loss first. Biomechanical stability degrades once glenoid loss reaches 15% to 20%, and reconstruction is indicated beyond 20% to 25%. A 30% defect raises contact pressures 300% to 400%, so leaving it unaddressed sets up recurrence.
The key mental model: match graft curvature to the joint. Distal tibial allograft fits the glenoid radius in 94% of specimens and beats a cartilage-free coracoid on contact mechanics, which is why it is gaining traction for anterior reconstruction.
For Hill-Sachs lesions, use the glenoid track (83% of glenoid width) to decide. Off-track lesions engage and often need a humeral-head allograft to restore geometry and prevent engagement. Remember the logistics: fresh grafts preserve chondrocytes but viability falls off after 28 days, so counsel the patient about the wait and the roughly 2-week scheduling window.